Imaging modalities using magnetic nanoparticles - overview of the developments in recent years - Schwarz, Marc; Dörfler, Arnd; Engelhorn, Tobias; Struffert, Tobias; Tietze, Rainer; Janko, Christina; Tripal, Philipp; Cicha, Iwona; Dürr, Stephan; Alexiou, Christoph; Lyer, Stefan (Nanotechnology Reviews, 2013)
The use of nanoparticles in tumor imaging, molecular imaging, and drug delivery has significantly expanded in the last few years. The relatively new field of "theranostics" combines their capacity for drug delivery with their potential as contrast agents. Depending on the imaging modality used, several types of nanoparticles are available, such as gold for optical imaging or superparamagnetic iron oxide for magnetic resonance imaging. This review will give a short overview of the different types of nanoparticles as well as their development and potential application in recent years. Furthermore, it describes the research on classic imaging modalities as well as on new techniques to image nanoparticles in vivo and focuses on magnetic-based imaging modalities.
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Imaging of common hip pathologies in runners - Friedman, Jonathan M.; Diaz, Luis E.; Roemer, Frank; Guermazi, Ali (JPN J RADIOL, 2023)
Running is an increasingly popular sport and form of exercise. Because of the importance of the hip in the biomechanics involved with running, forming the primary connection between the axial and appendicular skeleton of the lower extremities, accurate diagnosis and reporting of hip pathology are vital for appropriate management. This review provides an overview of the most common hip pathologies and injuries encountered in runners. Radiologic studies, primarily conventional radiography and magnetic resonance imaging (MRI) provide useful diagnostic information and should be used in combination with clinical findings to help guide therapeutic management.
CRIS-Team Scopus Importer:2023-01-13
Keywords: Conventional radiograph; Hip injuries; MRI; Runners; Ultrasound

Imaging of Common Rheumatic Joint Diseases Affecting the Upper Limbs - Boesen, Mikael; Roemer, Frank; Østergaard, Mikkel; Maas, Mario; Terslev, Lene; Guermazi, Ali (Radiologic Clinics of North America, 2019)
Imaging plays an important role in diagnosis and monitoring of rheumatic diseases of the upper limb. Many rheumatic diseases present with similar clinical pictures, especially in the early stages. Imaging findings in inflammatory and degenerative joint diseases often are nonspecific, especially in the early stages. Imaging findings should be interpreted in light of the clinical context—clinical and paraclinical findings. Good referrals with short clinical history, main clinical findings, disease-involved joint(s), pain distribution, and relevant blood tests increase the likelihood of a correct diagnosis.
CRIS-Team Scopus Importer:2019-06-21
Keywords: Conventional radiography; CT; Imaging; MR imaging; Osteoarthritis; Rheumatoid arthritis; Rheumatology; Ultrasound

Imaging of muscle injuries in soccer - Heiß, Rafael; Tol, Johannes L.; Pogarell, Tobias; Roemer, Frank; Reurink, Guus; Renoux, Jerome; Crema, Michel D.; Guermazi, Ali (Skeletal Radiology, 2023)
Accurate diagnosis of muscle injuries is a challenge in everyday clinical practice and may have profound impact on the recovery and return-to-play decisions of professional athletes particularly in soccer. Imaging techniques such as ultrasound and magnetic resonance imaging (MRI), in addition to the medical history and clinical examination, make a significant contribution to the timely structural assessment of muscle injuries. The severity of a muscle injury determined by imaging findings has a decisive influence on therapy planning and affects prognosis. Imaging is of high importance when the diagnosis or grade of injury is unclear, when recovery is taking longer than expected, and when interventional or surgical management may be needed. This narrative review will discuss ultrasound and MRI for the assessment of sports-related muscle injuries in the context of soccer, including advanced imaging techniques, with the focus on the clinical relevance of imaging findings for the prediction of return to play.
CRIS-Team Scopus Importer:2023-12-01
Keywords: Magnetic resonance imaging; Muscle; Muscle injury; Return to play; Soccer; Sports injuries; Ultrasound

Imaging of muscle injuries in sports medicine - Heiß, Rafael; Janka, Rolf Matthias; Uder, Michael; Hotfiel, Thilo; Gast, Lena; Nagel, Armin Michael; Roemer, Frank (Die Radiologie, 2023)
Background: Early diagnosis of muscle injuries is indispensable in order to initiate appropriate treatment and to facilitate optimal healing.Purpose: The aim of this review is to provide an update on imaging of muscle injuries in sports medicine with a focus on ultrasound and magnetic resonance imaging (MRI) and to present experimental approaches in addition to routine diagnostic procedures.Materials and methods: A PubMed literature search for the years 2012-2022 using the following keywords was performed: muscle, muscle injury, muscle imaging, muscle injury classification, delayed onset muscle soreness, ultrasound, MRI, sodium MRI, potassium MRI, ultra-high-field MRI, injuries of athletes.Results: Imaging is crucial to confirm and assess the extent of sports-related muscle injuries and may help establishing treatment decisions, which directly affect the prognosis. This is of importance when the diagnosis or grade of injury is unclear, when recovery is taking longer than expected, and when interventional or surgical management may be necessary. In addition to established methods such as B-mode ultrasound and H-1-MRI, individual studies show promising approaches to further improve the imaging of muscle injuries in the future. Prior to the integration of contrast-enhanced ultrasound and X-nuclei into clinical routine, additional studies are needed to validate these techniques further.Conclusion: B-mode ultrasound represents an easily available, cost-effective modality for the initial diagnosis of muscle injuries. MRI is still considered the reference standard and enables an accurate morphological assessment of the extent of the injury. There are still no imaging approaches available for the objective determination of the optimal point of return to play.
CRIS-Team WoS Importer:2023-03-24

Imaging of Muscle Injuries in Sports Medicine: Sports Imaging Series - Guermazi, Ali; Roemer, Frank; Robinson, Philip; Tol, Johannes L.; Regatte, Ravindar R.; Crema, Michel D. (Radiology, 2017)
In sports-related muscle injuries, the main goal of the sports medicine physician is to return the athlete to competition-balanced against the need to prevent the injury from worsening or recurring. Prognosis based on the available clinical and imaging information is crucial. Imaging is crucial to confirm and assess the extent of sports-related muscle injuries and may help to guide management, which directly affects the prognosis. This is especially important when the diagnosis or grade of injury is unclear, when recovery is taking longer than expected, and when interventional or surgical management may be necessary. Several imaging techniques are widely available, with ultrasonography and magnetic resonance imaging currently the most frequently applied in sports medicine. This state of the art review will discuss the main imaging modalities for the assessment of sports-related muscle injuries, including advanced imaging techniques, with the focus on the clinical relevance of imaging features of muscle injuries. (©) RSNA, 2017 Online supplemental material is available for this article.
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Imaging of non-osteochondral tissues in osteoarthritis - Guermazi, A.; Roemer, Frank; Crema, M. D.; Englund, Martin; Hayashi, D. (Osteoarthritis and Cartilage, 2014)
The aim of this review is to describe imaging techniques for evaluation of non-osteochondral structures such as the synovium, menisci in the knee, labrum in the hip, ligaments and muscles and to review the literature from recent clinical and epidemiological studies of OA.This is a non-systematic narrative review of published literature on imaging of non-osteochondral tissues in OA. PubMed and MEDLINE search for articles published up to 2014, using the keywords osteoarthritis, synovitis, meniscus, labrum, ligaments, plica, muscles, magnetic resonance imaging (MRI), ultrasound, computed tomography (CT), scintigraphy, and positron emission tomography (PET).Published literature showed imaging of non-osteochondral tissues in OA relies primarily on MRI and ultrasound. The use of semiquantitative and quantitative imaging biomarkers of non-osteochondral tissues in clinical and epidemiological OA studies is reported. We highlight studies that have compared both imaging methodologies directly, and those that have established a relationship between imaging biomarkers and clinical outcomes. We provide recommendations as to which imaging protocols should be used to assess disease-specific changes regarding synovium, meniscus in the knee, labrum in the hip, and ligaments, and highlight potential pitfalls in their usage.MRI and ultrasound are currently the most useful imaging modalities for evaluation of non-osteochondral tissues in OA. MRI evaluation of any tissue needs to be performed using appropriate MR pulse sequences. Ultrasound may be particularly useful for evaluation of small joints of the hand. Nuclear medicine and CT play a limited role in imaging of non-osteochondral tissues in OA.
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Imaging of OA – From disease modification to clinical utility - Hayashi, Daichi; Roemer, Frank; Eckstein, Felix; Samuels, Jonathan; Guermazi, Ali (Best Practice & Research in Clinical Rheumatology, 2020)
Multiple disease-modifying osteoarthritis drug (DMOAD) trials were done in the last two decades, but no pharmacological agent has yet been approved by regulatory agencies as an effective therapy to date. Given the fact that we have seen the recent discontinuation of several late-stage drug development trials, a careful strategy is needed in formulating a plan for a successful DMOAD trial – including the various roles of imaging. This narrative review article will summarize how imaging is utilized in osteoarthritis from the perspective of disease modification to clinical utility. We will describe how semi-quantitative and quantitative magnetic resonance imaging approaches have been deployed in DMOAD trials. We will then review the utility of musculoskeletal ultrasound in research and clinical settings. Finally, novel hybrid positron emission tomography/MRI techniques and current research using artificial intelligence will be discussed, focusing on original research. Older publications are included for the discussion of the previous DMOAD trials and other relevant topics where deemed appropriate.
CRIS-Team Scopus Importer:2020-09-25
Keywords: Clinical trials; DMOAD; MRI; Osteoarthritis

Imaging of Osteoarthritis by Conventional Radiography, MR Imaging, PET–Computed Tomography, and PET–MR Imaging - Hayashi, Daichi; Roemer, Frank; Guermazi, Ali (PET Clinics, 2019)
Radiography remains the first-line imaging tool to characterize structural changes of osteoarthritis (OA) in both clinical and research settings, but MRI continues to play a large role in OA research. Compositional MRI enables evaluation of the biochemical properties of joint tissues, allowing assessment of early “premorphologic” changes that cannot be depicted on conventional MRI Hybrid PET-CT and PET–MRI allow integration of high-resolution structural information on CT and MRI with metabolic information obtained from PET related to OA disease process. We describe OA imaging by means of conventional radiography, MRI PET-CT, and PET–MRI.
CRIS-Team Scopus Importer:2019-11-29
Keywords: CT; MR imaging; Osteoarthritis; PET; Radiography

Imaging of osteoarthritis-recent research developments and future perspective - Hayashi, Daichi; Roemer, Frank; Guermazi, Ali (British Journal of Radiology, 2018)
In osteoarthritis research, imaging plays an important role in clinical trials and epidemiological observational studies. In this narrative review article, we will describe recent developments in imaging of osteoarthritis in the research arena, mainly focusing on literature evidence published within the past 3 years (2014-2017). We will primarily focus on MRI including advanced imaging techniques that are not currently commonly used in routine clinical practice, although radiography, ultrasound and nuclear medicine (radiotracer) imaging will also be discussed. Research efforts to uncover the disease process of OA as well as to discover a disease modifying OA drug continue. MRI continues to play a large role in these endeavors, while compositional MRI techniques will increasingly become important due to their ability to assess "premorphologic" biochemical changes of articular cartilage and other tissues in and around joints. Radiography remain the primary imaging modality for defining inclusion/exclusion criteria as well as an outcome measure in OA clinical trials, despite known limitations for visualization of OA features. Compositional MRI techniques show promise for predicting structural and clinical outcomes in OA research. Ultrasound can be a useful adjunct to radiography and MRI particularly for evaluation of hand OA. Newer imaging techniques such as hybrid PET/MRI may have a potential but require further research and validation.
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Imaging of patellar fractures - Jarraya, Mohamed; Diaz, Luis E.; Arndt, William F.; Roemer, Frank; Guermazi, Ali (Insights into Imaging, 2017)
Patellar fractures account for approximately 1% of all skeletal fractures and may result from direct, indirect, or combined trauma. Because of the importance of patellar integrity for knee extension and the risk of associated injury to the extensor mechanism, accurate reporting and description of fracture type is paramount for appropriate management. This pictorial essay aims to review the normal anatomy of the patella, the mechanisms of injury and different types of patellar fractures, with a brief introduction to therapeutic management. Teaching Points o Patellar fractures are classified according to their morphology and degree of displacement.o Direct trauma results in stellate fractures.o Indirect trauma results in transverse fractures.o Displacement should raise suspicion for retinacular injury.
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Imaging of the head and neck region - Lell, Michael; Mantsopoulos, K.; Uder, Michael; Wüst, Wolfgang (HNO, 2016)
Tumors of the head and neck are predominantly squamous cell carcinomas and those of the salivary glands are predominantly adenocarcinomas, adenoid cystic carcinomas and mucoepidermoid carcinomas. In 2011 the incidence of tumors of the oral cavity and pharynx in Germany was 6839 (5026 male and 1813 female) and of the larynx 1878 (1642 male and 236 female). The incidence of tumors of the nose and paranasal sinuses (467) and salivary glands (470) were much lower (www.krebsdaten.de/abfrage). The primary aim of imaging in head and neck cancer is staging of the disease and a precise assessment of tumor invasion. This information is essential for therapy decision-making (i. e. surgery or radiochemotherapy), planning of the extent of resection and subsequent reconstructive measures and also estimation of functional deficits after therapy. Computed tomography (CT) and magnetic resonance imaging (MRI) are the imaging modalities of choice but both have specific advantages and disadvantages. In certain cases both CT and MRI need to be performed for accurate treatment planning.
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Imaging of the head and neck region - Lell, Michael; Mantsopoulos, K.; Uder, Michael; Wüst, Wolfgang (Radiologe, 2016)
Tumors of the head and neck are predominantly squamous cell carcinomas and those of the salivary glands are predominantly adenocarcinomas, adenoid cystic carcinomas and mucoepidermoid carcinomas. In 2011 the incidence of tumors of the oral cavity and pharynx in Germany was 6839 (5026 male and 1813 female) and of the larynx 1878 (1642 male and 236 female). The incidence of tumors of the nose and paranasal sinuses (467) and salivary glands (470) were much lower ( www.krebsdaten.de/abfrage ). The primary aim of imaging in head and neck cancer is staging of the disease and a precise assessment of tumor invasion. This information is essential for therapy decision-making (i. e. surgery or radiochemotherapy), planning of the extent of resection and subsequent reconstructive measures and also estimation of functional deficits after therapy. Computed tomography (CT) and magnetic resonance imaging (MRI) are the imaging modalities of choice but both have specific advantages and disadvantages. In certain cases both CT and MRI need to be performed for accurate treatment planning.
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Imaging of the musculoskeletal system using low-field magnetic resonance imaging - Pogarell, Tobias; May, Matthias; Nagel, Armin Michael; Uder, Michael; Heiß, Rafael (Radiologe, 2022)
Background Magnetic resonance imaging (MRI) plays a crucial role in musculoskeletal imaging. The high prevalence and pain-related suffering of patients pose a particular challenge concerning availability and turnover times, respectively. Low-field (<= 1.0 T) MRI has the potential to fulfill these needs. However, during the past three decades, high field systems have increasingly replaced low field systems because of their limitations in image quality. Recent technological advancements in high-performance hard- and software promise musculoskeletal imaging with adequate quality at lower field strengths for several regions and indications. Objectives The goal is to provide insight into the advantages and disadvantages of low-field musculoskeletal imaging, discuss the current literature, and include our first experiences with a modern 0.55 T MRI. Materials and methods This review is based on research in various literature databases and our own musculoskeletal imaging experiences with a modern 0.55 T scanner. Conclusion Most publications pertaining to musculoskeletal imaging at low-field strength MRI are outdated, and studies regarding the diagnostic performance of modern low-field MRI systems are needed. These new systems may complement existing high-field systems and make MRI more accessible, even in low-income countries. From our own experience, modern low-field MRI seems to be adequate in musculoskeletal imaging, especially in acute injuries.
CRIS-Team WoS Importer:2022-04-29
Keywords: Field strength; Musculoskeletal injuries; Image quality; Cost; Sustainability

Imaging Review of Subscapularis Tendon and Rotator Interval Pathology - Ahmad, Zohaib Y.; Diaz, Luis E.; Roemer, Frank; Goud, Ajay; Guermazi, Ali (Radiology Research and Practice, 2022)
As the largest rotator cuff muscle, the subscapularis plays a major role in stabilizing the glenohumeral joint, in conjunction with surrounding rotator cuff structures. Injury to the subscapularis tendon can be isolated, but more commonly is seen in conjunction with supraspinatus tendon pathology. Injury can be associated with biceps pulley instability, superior labral anterior-posterior (SLAP) tears, humeral head subluxation, and anterosuperior and coracoid impingements. The involvement of the rotator interval can lead to what is called "the hidden lesion," due to its difficulty to diagnose during arthroscopy. Understanding the anatomical relations of the subscapularis tendon with the rest of the rotator cuff and rotator interval, as well as common patterns of injury that involve the subscapularis tendon, can aid in proper diagnosis of these injuries leading to prompt surgical repair. This review describes the anatomy of the subscapularis muscle and tendon, and the magnetic resonance imaging (MRI) patterns of subscapularis tendon injury.
CRIS-Team WoS Importer:2022-03-18

Imaging temporomandibular disorders: Reliability of a novel MRI-based scoring system - Willenbrock, Dorina; Lutz, Rainer; Wüst, Wolfgang; Heiß, Rafael; Uder, Michael; Behrends, Tessa; Wurm, Matthias; Kesting, Marco Rainer; Wiesmüller, Marco (Journal of Cranio-Maxillofacial Surgery, 2022)
The aim of this study was to assess the inter- and intrarater reliability of a recently proposed scoring system for temporomandibular disorders (TMD), based upon radiological findings from magnetic resonance imaging (MRI). Patients with clinically suspected uni- or bilateral TMD, and subsequently conducted MRI examination of both temporomandibular joints, were included in this study. MRI data were independently evaluated by two experienced radiologists according to the DLJ scoring system proposed by Wurm et al., which includes assessment of the following categories: articular disk (prefix ‘D’), direction of disk luxation (prefix ‘L’), and osseous joint alterations (prefix ‘J’). 60 patients (49 female and 11 male) were eligible for analysis. No significant differences were found between both observers regarding ‘D’ and ‘L’ scores (p = 0.13 and p = 0.59, respectively). Significant differences were found for the assessment of subtle osseous changes (‘J0’ category: p = 0.041; ‘J1’ category: p = 0.018). Almost perfect intra- and interrater agreements were found for ‘D’ and ‘L’ categories (intrarater and interrater agreements for ‘D’: κ = 0.92 and κ = 0.84, respectively; intrarater and interrater agreements for ‘L’: κ = 0.93 and κ = 0.89, respectively). However, the assessment of ‘J’ categories revealed only moderate interrater agreement (κ = 0.49). The DLJ scoring system based upon MRI findings is feasible for routine clinical TMD assessment, and may help to simplify interdisciplinary communication between radiologists and clinicians.
CRIS-Team Scopus Importer:2022-04-08
Keywords: DLJ score; Magnetic resonance imaging; MRI; Temporomandibular disorder; TMD

Imaging the Parasinus Region with a Third-Generation Dual-Source CT and the Effect of Tin Filtration on Image Quality and Radiation Dose - Lell, Michael; May, Matthias; Brand, Michael; Eller, A.; Buder, Thomas; Hofmann, Eva Maria; Uder, Michael; Wüst, Wolfgang (American Journal of Neuroradiology, 2015)
CT is the imaging technique of choice in the evaluation of midface trauma or inflammatory disease. We performed a systematic evaluation of scan protocols to optimize image quality and radiation exposure on third-generation dual-source CT.CT protocols with different tube voltage (70-150 kV), current (25-300 reference mAs), prefiltration, pitch value, and rotation time were systematically evaluated. All images were reconstructed with iterative reconstruction (Advanced Modeled Iterative Reconstruction, level 2). To individually compare results with otherwise identical factors, we obtained all scans on a frozen human head. Conebeam CT was performed for image quality and dose comparison with multidetector row CT. Delineation of important anatomic structures and incidental pathologic conditions in the cadaver head was evaluated.One hundred kilovolts with tin prefiltration demonstrated the best compromise between dose and image quality. The most dose-effective combination for trauma imaging was Sn100 kV/250 mAs (volume CT dose index, 2.02 mGy), and for preoperative sinus surgery planning, Sn100 kV/150 mAs (volume CT dose index, 1.22 mGy). "Sn" indicates an additional prefiltration of the x-ray beam with a tin filter to constrict the energy spectrum. Exclusion of sinonasal disease was possible with even a lower dose by using Sn100 kV/25 mAs (volume CT dose index, 0.2 mGy).High image quality at very low dose levels can be achieved by using a Sn100-kV protocol with iterative reconstruction. The effective dose is comparable with that of conventional radiography, and the high image quality at even lower radiation exposure favors multidetector row CT over conebeam CT.
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Immunoglobulin G-dependent inhibition of inflammatory bone remodeling requires pattern recognition receptor Dectin-1 - Seeling, Michaela; Pöhnl, Matthias; Kara, Sibel; Horstmann, Nathalie; Riemer, Carolina Daniela; Wöhner, Miriam; Liang, Chunguang; Brückner, Christin; Eiring, Patrick; Werner, Anja; Biburger, Markus; Altmann, Leon; et al. (Immunity, 2023)
Immunoglobulin G (IgG) antibodies are major drivers of inflammation during infectious and autoimmune diseases. In pooled serum IgG (IVIg), however, antibodies have a potent immunomodulatory and anti-inflammatory activity, but how this is mediated is unclear. We studied IgG-dependent initiation of resolution of inflammation in cytokine- and autoantibody-driven models of rheumatoid arthritis and found IVIg sialylation inhibited joint inflammation, whereas inhibition of osteoclastogenesis was sialic acid independent. Instead, IVIg-dependent inhibition of osteoclastogenesis was abrogated in mice lacking receptors Dectin-1 or FcγRIIb. Atomistic molecular dynamics simulations and super-resolution microscopy revealed that Dectin-1 promoted FcγRIIb membrane conformations that allowed productive IgG binding and enhanced interactions with mouse and human IgG subclasses. IVIg reprogrammed monocytes via FcγRIIb-dependent signaling that required Dectin-1. Our data identify a pathogen-independent function of Dectin-1 as a co-inhibitory checkpoint for IgG-dependent inhibition of mouse and human osteoclastogenesis. These findings may have implications for therapeutic targeting of autoantibody and cytokine-driven inflammation.
CRIS-Team Scopus Importer:2023-05-12
Keywords: bone; Dectin-1; Fc-receptor; glycosylation; IgG; inflammation; osteoclast; rheumatoid arthritis

Immunological and clinical consequences of splenectomy in a multiple sclerosis patient treated with natalizumab - Lee, De-Hyung; Waschbisch, Anne; Laemmer, Alexandra B.; Dörfler, Arnd; Schwab, Stefan; Linker, Ralf (Journal of Neuroinflammation, 2013)
Objective: Here we report a case of a splenectomized white woman with natalizumab-associated progressive multifocal leukoencephalopathy (PML), occurring as early as after 11 infusions and provide blood fluorescence-activated cell sorting (FACS) analyses before and after natalizumab treatment.Design: This is a report of a single case with immunological studies.Methods: Methods comprised neurologic examination, magnetic resonance imaging, and cerebrospinal fluid (CSF) studies as well as immune cell FACS analyses from blood.Results: Diagnosis of PML was established after positive John Cunningham virus (JCV) DNA was detected in the CSF. An immune reconstitution inflammatory syndrome was treated with repeated cycles of steroid pulses and intravenous immunoglobulins. Reduced numbers of memory B cells, which might play an important role in antiviral immune response, were detected in the blood. Moreover the percentage of CD19+ B cells was elevated in our post-splenectomy patient as compared to a control cohort of multiple sclerosis (MS) patients under natalizumab therapy.Conclusion: Splenectomy may increase the risk for the development of natalizumab-associated PML via effects on the B cell compartment. It may be regarded as a risk factor in MS patients independent from the duration of disease. © 2013 Lee et al.; licensee BioMed Central Ltd.
CRIS-Team Scopus Importer:2022-08-05
Keywords: CD19 positive B cells; Multiple sclerosis; Natalizumab; Progressive multifocal leukoencephalopathy; Splenectomy

IMPACT OF CLIMBING ACTIVITY AND AGE ON CARTILAGE STRUCTURAL COMPOSITION OF THE METACARPOPHALANGEAL AND PROXIMAL INTERPHALANGEAL JOINTS AS ASSESSED BY T2 RELAXOMETRY AT 7T MRI - Heiß, Rafael; Bayer, T.; Janka, Rolf Matthias; Brockhoff, Marie-Jo; Uder, Michael; Nagel, Armin Michael; Roemer, Frank (OSTEOARTHRITIS AND CARTILAGE, 2020)
CRIS-Team WoS Importer:2020-05-29

Impact of contralateral radiographic status on longitudinal change of cartilage transverse relaxation time (T2) in radiographically normal knees, a model of early OA? - data from the osteoarthritis initiative - Maschek, S.; Wirth, W.; Roemer, Frank; Duda, G. N.; Sharma, L.; Eckstein, F. (OSTEOARTHRITIS AND CARTILAGE, 2019)
CRIS-Team WoS Importer:2019-05-21

Impact of Contrast Media Concentration on Low-Kilovolt Computed Tomography Angiography: A Systematic Preclinical Approach - Fleischmann, Ulrike; Pietsch, Hubertus; Korporaal, Johannes G.; Flohr, Thomas G.; Uder, Michael; Jost, Gregor; Lell, Michael M. (Investigative Radiology, 2018)
OBJECTIVES: Low peak kilovoltage (kVp) protocols in computed tomography angiography (CTA) demand a review of contrast media (CM) administration practices. The aim of this study was to systematically evaluate different iodine concentrations of CM in a porcine model. MATERIALS AND METHODS: Dynamic 70 kVp CTA was performed on 7 pigs using a third-generation dual-source CT system. Three CM injection protocols (A-C) with an identical total iodine dose and iodine delivery rate (150 mg I/kg, 12 s, 0.75 g I/s) differed in iodine concentration and flow rate (protocol A: 400 mg I/mL, 1.9 mL/s; B: 300 mg I/mL, 2.5 mL/s; C: 150 mg I/mL, 5 mL/s). All protocols were applied in a randomized order and compared intraindividually. Arterial enhancement at different locations in the pulmonary artery, the aorta, and aortic branches was measured over time. Time attenuation curves, peak enhancement, time to peak, and bolus tracking delay times needed for static CTA were calculated. The reproducibility of optimal parameters was tested in single-phase CTA. RESULTS: The heart rates of the pigs were comparable for all protocols (P > 0.7). The injection pressure was significantly higher for protocol A (64 ± 5 psi) and protocol C (55 ± 3 psi) compared with protocol B (39 ± 2 psi) (P < 0.001). Average arterial peak enhancement in the dynamic scans was 359 ± 51 HU (protocol A), 382 ± 36 HU (B), and 382 ± 60 HU (C) (A compared with B and C: P < 0.01; B compared with C: P = 0.995). Time to peak enhancement decreased with increasing injection rate. The delay time for bolus tracking depended on the injection rate as well and was highest for protocol A (4.7 seconds) and lowest for protocol C (3.9 seconds) (P = 0.038). The peak enhancement values of the dynamic scans highly correlated with those of the single-phase CTA scans. CONCLUSIONS: In 70 kVp CTA, 300 mg I/mL iodine concentrations showed to be superior to high-concentration CM when keeping the iodine delivery rate constant. Besides, iodine concentrations as low as 150 mg I/mL can be administered without compromising vascular enhancement. This opens up new possibilities in CM administration.
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Impact of dietary vitamin D on immunoregulation and disease pathology in lupus-prone NZB/W F1 mice - Kraemer, Antoine N.; Schäfer, Anna Lena; Sprenger, Dalina T.L.; Sehnert, Bettina; Williams, Johanna P.; Luo, Aileen; Riechert, Laura; Al-Kayyal, Qusai; Dumortier, Hélène; Fauny, Jean Daniel; Winter, Zoltan; Heim, Kathrin; et al. (Frontiers in Immunology, 2022)
Vitamin D (VD) deficiency is a highly prevalent worldwide phenomenon and is extensively discussed as a risk factor for the development of systemic lupus erythematosus (SLE) and other immune-mediated diseases. In addition, it is now appreciated that VD possesses multiple immunomodulatory effects. This study aims to explore the impact of dietary VD intake on lupus manifestation and pathology in lupus-prone NZB/W F1 mice and identify the underlying immunological mechanisms modulated by VD. Here, we show that low VD intake accelerates lupus progression, reflected in reduced overall survival and an earlier onset of proteinuria, as well higher concentrations of anti-double-stranded DNA autoantibodies. This unfavorable effect gained statistical significance with additional low maternal VD intake during the prenatal period. Among examined immunological effects, we found that low VD intake consistently hampered the adoption of a regulatory phenotype in lymphocytes, significantly reducing both IL-10-expressing and regulatory CD4+ T cells. This goes along with a mildly decreased frequency of IL-10-expressing B cells. We did not observe consistent effects on the phenotype and function of innate immune cells, including cytokine production, costimulatory molecule expression, and phagocytic capacity. Hence, our study reveals that low VD intake promotes lupus pathology, likely via the deviation of adaptive immunity, and suggests that the correction of VD deficiency might not only exert beneficial functions by preventing osteoporosis but also serve as an important module in prophylaxis and as an add-on in the treatment of lupus and possibly other immune-mediated diseases. Further research is required to determine the most appropriate dosage, as too-high VD serum levels may also induce adverse effects, possibly also on lupus pathology.
CRIS-Team Scopus Importer:2022-12-16
Keywords: autoimmune; autoimmunity; choleacliferol; diet; lupus; mice; SLE; vitamin D

Impact of different cephalometric skeletal configurations on anatomic midface parameters in adults - Willershausen, Ines; Ehrenfried, Amelie; Krautkremer, Franziska; Ströbel, Armin; Seidel, Corinna Lesley; Paulsen, Friedrich; Kopp, Markus; Uder, Michael; Gölz, Lina; May, Matthias (Clinical Oral Investigations, 2024)
Objectives: Skull morphology and growth patterns are essential for orthodontic treatment, impacting clinical decision making. We aimed to determine the association of different cephalometric skeletal configurations on midface parameters as measured in 3D CT datasets. Materials and methods: After sample size calculation, a total of 240 fully dentulous patients between 20 and 79 years of age (mean age: 42 ± 15), who had received a CT of the skull within the scope of trauma diagnosis or intracranial bleeding, were retrospectively selected. On the basis of cephalometric analysis, using MPR reconstructions, patients were subdivided into three different vertical skull configurations (brachyfacial, mesofacial, dolichofacial) and the respective skeletal Class I, II, and III relationships. Anatomic parameters were measured using a three-dimensional post-processing console: the thickness of the maxillary and palatine bones as well as the alveolar crest, maxillary body and sutural length, width and height of the hard palate, maxillary facial wall thickness, and masseter muscle thickness and length. Results: Individuals with brachyfacial configurations had a significantly increased palatal and alveolar ridge thicknesses compared to those with dolichofacial- or mesofacial configurations. Brachyfacial configurations presented a significantly increased length and thickness of the masseter muscle (4.599 cm; 1.526 cm) than mesofacial (4.431 cm; 1.466 cm) and dolichofacial configurations (4.405 cm; 1.397 cm) (p < 0.001). Individuals with a skeletal Class III had a significantly shorter palatal length (5.313 cm) than those with Class I (5.406 cm) and Class II (5.404 cm) (p < 0.01). Sutural length was also significantly shorter in Class III (p < 0.05). Conclusions: Skeletal configurations have an impact on parameters of the bony skull. Also, measurable adaptations of the muscular phenotype could result. Clinical relevance: The association between viscerocranial morphology and midface anatomy might be beneficial for tailoring orthodontic appliances to individual anatomy and planning cortically anchored orthodontic appliances.
CRIS-Team Scopus Importer:2024-01-12
Keywords: Anatomy; Cephalometry; Computed tomography; Midface; Orthodontics; Ultra-high-resolution datasets

Impact of Endothelial Progenitor Cells in the Vascularization of Osteogenic Scaffolds - Steiner, Dominik; Reinhardt, Lea; Fischer, Laura; Popp, Vanessa; Körner, Carolin; Geppert, Carol-Immanuel; Bäuerle, Tobias; Horch, Raymund E.; Arkudas, Andreas (Cells, 2022)
The microvascular endothelial network plays an important role in osteogenesis, bone regeneration and bone tissue engineering. Endothelial progenitor cells (EPCs) display a high angiogenic and vasculogenic potential. The endothelialization of scaffolds with endothelial progenitor cells supports vascularization and tissue formation. In addition, EPCs enhance the osteogenic differentiation and bone formation of mesenchymal stem cells (MSCs). This study aimed to investigate the impact of EPCs on vascularization and bone formation of a hydroxyapatite (HA) and beta-tricalcium phosphate (ß-TCP)–fibrin scaffold. Three groups were designed: a scaffold-only group (A), a scaffold and EPC group (B), and a scaffold and EPC/MSC group (C). The HA/ß–TCP–fibrin scaffolds were placed in a porous titanium chamber permitting extrinsic vascularization from the surrounding tissue. Additionally, intrinsic vascularization was achieved by means of an arteriovenous loop (AV loop). After 12 weeks, the specimens were explanted and investigated by histology and CT. We were able to prove a strong scaffold vascularization in all groups. No differences regarding the vessel number and density were detected between the groups. Moreover, we were able to prove bone formation in the coimplantation group. Taken together, the AV loop is a powerful tool for vascularization which is independent from scaffold cellularization with endothelial progenitor cells’ prior implantation.
CRIS-Team Scopus Importer:2022-03-18
Keywords: AV loop; Bone tissue engineering; Endothelial progenitor cell; Mesenchymal stem cell; Vascularization

Impact of Hypothermia Initiation and Duration on Perihemorrhagic Edema Evolution After Intracerebral Hemorrhage - Volbers, Bastian; Herrmann, Sabrina; Willfarth, Wolfgang; Lücking, Hannes; Kloska, Stephan; Dörfler, Arnd; Huttner, Hagen; Kuramatsu, Joji; Schwab, Stefan; Staykov, Dimitre (Stroke, 2016)
Intracerebral hemorrhage (ICH) causes high morbidity and mortality. Recently, perihemorrhagic edema (PHE) has been suggested as an important prognostic factor. Therapeutic hypothermia may be a promising therapeutic option to treat PHE. However, no data exist about the optimal timing and duration of therapeutic hypothermia in ICH. We examined the impact of therapeutic hypothermia timing and duration on PHE evolution.In this retrospective, single-center, case-control study, we identified patients with ICH treated with mild endovascular hypothermia (target temperature 35°C) from our institutional database. Patients were grouped according to hypothermia initiation (early: days 1-2 and late: days 4-5 after admission) and hypothermia duration (short: 4-8 days and long: 9-15 days). Patients with ICH matched for ICH volume, age, ICH localization, and intraventricular hemorrhage were identified as controls. Relative PHE, temperature, and intracranial pressure course were analyzed. Clinical outcome on day 90 was assessed using the modified Rankin scale (0-3=favorable and 4-6=poor).Thirty-three patients with ICH treated with hypothermia and 37 control patients were included. Early hypothermia initiation led to relative PHE decrease between admission and day 3, whereas median relative PHE increased in control patients (-0.05 [interquartile range, -0.4 to 0.07] and 0.07 [interquartile range, -0.07 to 0.26], respectively; P=0.007) and patients with late hypothermia initiation (0.22 [interquartile range 0.12-0.27]; P=0.037). After day 3, relative PHE increased in all groups without difference. Outcome was not different between patients treated with hypothermia and controls.Early hypothermia initiation after ICH onset seems to have an important impact on PHE evolution, whereas our data suggest only limited impact later than day 3 after onset.
EVALuna2:22477

Impact of interhospital transfer vs. direct admission on acute ischemic stroke patients: A subset analysis of the COMPLETE registry - Hassan, Ameer E.; Zaidat, Osama O.; Nanda, Ashish; Atchie, Benjamin; Woodward, Keith; Dörfler, Arnd; Tomasello, Alejandro; Fifi, Johanna T.; Complete Registry Investigators, (Frontiers in Neurology, 2022)
Background: Efficacy of thrombectomy treatment in acute ischemic stroke large vessel occlusion (AIS-LVO) patients is time dependent. Direct admission to thrombectomy centers (vs. interhospital transfer) may reduce time to treatment and improve outcomes. In this subset analysis of the COMPLETE registry, we compared outcomes between direct to thrombectomy center (Direct) vs. transfer from another hospital to thrombectomy center (Transfer) in AIS-LVO patients treated with aspiration thrombectomy. Methods: COMPLETE was a prospective, international registry that enrolled patients from July 2018 to October 2019, with a 90-day follow-up period that was completed in January 2020. Imaging findings and safety events were adjudicated by core lab and independent medical reviewers, respectively. Pre-defined primary endpoints included post-procedure angiographic revascularization (mTICI & GE;2b), 90-day functional outcome (mRS 0-2), and 90-day all-cause mortality. Planned collections of procedural time metrics and outcomes were used in the present post-hoc analysis to compare outcomes between transfer and direct patient cohorts. Results: Of 650 patients enrolled, 343 were transfer [52.8% female; mean (SD) age, 68.2 (13.9) years], and 307 were direct [55.4% female; 68.5 (14.5) years] admit. Median onset-to-puncture time took longer in the transfer vs. direct cohort (5.65 vs. 3.18 h: 2.33 h difference, respectively; p < 0.001). There was no significant difference in successful revascularization rate, mTICI & GE;2b (88.3 and 87.3%), sICH at 24 h (3.8 and 3.9%), median length of hospital stay (7 and 6 days), and 90-day mortality (16.9 and 14.0%) between transfer vs. direct patients, respectively. However, achieving 90-day functional independence was less likely in transfer compared with direct patients (mRS 0-2 was 50.3 vs. 61.7%, p = 0.0056). Conclusions: In the COMPLETE registry, direct to thrombectomy center was associated with significantly shorter onset-to-puncture times, and higher rates of good clinical outcome across different geographies. Additional research should focus on AIS-LVO detection to facilitate direct routing of patients to appropriate treatment centers.
CRIS-Team WoS Importer:2022-09-02

Impact of Perihemorrhagic Edema on Short-Term Outcome After Intracerebral Hemorrhage - Volbers, Bastian; Willfarth, Wolfgang; Schwab, Sibylle; Kuramatsu, J. B.; Huttner, Hagen; Struffert, Tobias; Dörfler, Arnd; Staykov, S. (Neurocritical Care, 2016)
Intracerebral hemorrhage (ICH) is a devastating disease with ICH volume being the main predictor of poor outcome. The prognostic role of perihemorrhagic edema (PHE) is still unclear; however, available data are mainly derived from analyses during the first days after symptom onset. As PHE growth may continue up to 14 days after ICH, we evaluated PHE over a longer period of time and investigated its impact on short-term clinical outcome.In this monocentric retrospective cohort study, patients with spontaneous supratentorial ICH were identified from our institutional data base. Different time points of CT scans were merged to time clusters for better comparison (day 1, 2-3, 4-6, 7-9, 10-12). Absolute volumes of ICH and PHE were obtained using a validated semiautomatic volumetric algorithm. Clinical outcome at discharge was assessed using the modified Rankin Scale (0-3 = favorable, 4-6 = poor).220 patients (83 with favorable, 137 with poor outcome) were included in the final analysis. Mean ICH volume on admission was 22.8 [standard deviation (SD) 24.6] cm(3). Mean absolute PHE volume on admission was 22.5 (SD 20.8) cm(3) and increased to a mean peak volume of 38.1 (SD 31.4) cm(3) during 6.7 (SD 4.1) days on average. Besides GCS on admission, functional status before ICH, peak hematoma volume, lobar localization and fever burden, and high peak PHE volume predicted poor outcome at discharge [OR 0.977 (95 % CI 0.957-0.998)] in the multivariable analysis.PHE may have a negative impact on short-term functional outcome after ICH and therefore represent a possible treatment target.
EVALuna2:22273

Impact of post-processing methods on apparent diffusion coefficient values - Zeilinger, Martin Georg; Lell, Michael; Baltzer, Pascal Andreas Thomas; Dörfler, Arnd; Uder, Michael; Dietzel, Matthias (European Radiology, 2016)
The apparent diffusion coefficient (ADC) is increasingly used as a quantitative biomarker in oncological imaging. ADC calculation is based on raw diffusion-weighted imaging (DWI) data, and multiple post-processing methods (PPMs) have been proposed for this purpose. We investigated whether PPM has an impact on final ADC values.Sixty-five lesions scanned with a standardized whole-body DWI-protocol at 3 T served as input data (EPI-DWI, b-values: 50, 400 and 800 s/mm(2)). Using exactly the same ROI coordinates, four different PPM (ADC_1-ADC_4) were executed to calculate corresponding ADC values, given as [10(-3) mm(2)/s] of each lesion. Statistical analysis was performed to intra-individually compare ADC values stratified by PPM (Wilcoxon signed-rank tests: ? = 1 %; descriptive statistics; relative difference/?; coefficient of variation/CV).Stratified by PPM, mean ADCs ranged from 1.136-1.206 *10(-3) mm(2)/s (? = 7.0 %). Variances between PPM were pronounced in the upper range of ADC values (maximum: 2.540-2.763 10(-3) mm(2)/s, ? = 8 %). Pairwise comparisons identified significant differences between all PPM (P <= 0.003; mean CV = 7.2 %) and reached 0.137 *10(-3) mm(2)/s within the 25th-75th percentile.Altering the PPM had a significant impact on the ADC value. This should be considered if ADC values from different post-processing methods are compared in patient studies.o Post-processing methods significantly influenced ADC values. o The mean coefficient of ADC variation due to PPM was 7.2 %. o To achieve reproducible ADC values, standardization of post-processing is recommended.
EVALuna2:14601

Impact of renal denervation on tissue Na(+) content in treatment-resistant hypertension - Ott, Christian; Kopp, Christoph; Dahlmann, Anke; Schmid, Andrea; Linz, Peter; Hammon, Matthias; Ditting, Tilmann; Veelken, Roland; Uder, Michael; Titze, Jens; Schmieder, Roland; Cavallaro, Alexander Josef (Clinical Research in Cardiology, 2017)
Renal denervation (RDN) has been introduced for reducing blood pressure (BP) in treatment-resistant hypertension (TRH). The precise mechanism how RDN exerts its BP-lowering effects are not yet fully understood. It is widely accepted that sodium (Na(+)) plays a crucial role in the pathogenesis of hypertensive disease. However, there is increasing evidence of osmotically inactive Na(+) storage. We investigated the impact of RDN on Na(+) homeostasis using estimation of salt intake, and measurement of tissue Na(+) content.In a study 41 patients with TRH (office BP >=140/90 mmHg and diagnosis confirmed by 24-h ambulatory BP monitoring) underwent RDN. Tissue Na(+) content was assessed non-invasively with 3.0 T magnetic resonance imaging before and 6 months after RDN. In addition, 24-h urinary Na(+) excretion as an estimate of salt intake and spot urine Na(+)/K(+) excretion were assessed. The study was registered at http://www.clinicaltrials.gov (ID: NCT01687725).There was a significant fall in BP (office: -17 ± 20/-10 ± 12 mmHg; 24-h: -11 ± 13/-6 ± 9 mmHg, all p < 0.001) 6 months after RDN. In contrast, tissue Na(+) content of the muscle (20.1 ± 3.9 vs. 20.7 ± 4.0 mmol/L, p = 0.229) and skin (24.4 ± 6.5 vs. 24.8 ± 6.6 mmol/L, p = 0.695) did not change after RDN. Moreover, there was also no change in salt intake after RDN, whereas Na(+)/K(+) ratio only acutely increased.Although RDN resulted in a substantial reduction of BP, tissue Na(+) content of the muscle and skin was not mobilized and reduced. These data indicate that the BP reduction after RDN is unrelated to Na(+) homeostasis.
EVALuna2:3743

Impact of Single Dose Photons and Carbon Ions on Perfusion and Vascular Permeability: A Dynamic Contrast-Enhanced MRI Pilot Study in the Anaplastic Rat Prostate Tumor R3327-AT1 - Bendinger, Alina L.; Seyler, Lisa; Saager, Maria; Debus, Charlotte; Peschke, Peter; Komljenovic, Dorde; Debus, Jürgen; Peter, Jörg; Floca, Ralf O.; Karger, Christian P.; Glowa, Christin (Radiation Research, 2019)
We collected initial quantitative information on the effects of high-dose carbon (12C) ions compared to photons on vascular damage in anaplastic rat prostate tumors, with the goal of elucidating differences in response to high-LET radiation, using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Syngeneic R3327-AT1 rat prostate tumors received a single dose of either 16 or 37 Gy 12C ions or 37 or 85 Gy 6 MV photons (iso-absorbed and iso-effective doses, respectively). The animals underwent DCE-MRI prior to, and on days 3, 7, 14 and 21 postirradiation. The extended Tofts model was used for pharmacokinetic analysis. At day 21, tumors were dissected and histologically examined. The results of this work showed the following: 1. 12C ions led to stronger vascular changes compared to photons, independent of dose; 2. Tumor growth was comparable for all radiation doses and modalities until day 21; 3. Nonirradiated, rapidly growing control tumors showed a decrease in all pharmacokinetic parameters (area under the curve, Ktrans, ve, vp) over time; 4. 12C-ion-irradiated tumors showed an earlier increase in area under the curve and Ktrans than photon-irradiated tumors; 5. 12C-ion irradiation resulted in more homogeneous parameter maps and histology compared to photons; and 6. 12C-ion irradiation led to an increased microvascular density and decreased proliferation activity in a largely dose-independent manner compared to photons. Postirradiation changes related to 12C ions and photons were detected using DCE-MRI, and correlated with histological parameters in an anaplastic experimental prostate tumor. In summary, this pilot study demonstrated that exposure to 12C ions increased the perfusion and/or permeability faster and led to larger changes in DCE-MRI parameters resulting in increased vessel density and presumably less hypoxia at the end of the observation period when compared to photons. Within this study no differences were found between curative and sub-curative doses in either modality.
CRIS-Team Scopus Importer:2020-02-21

Impact of specificity on cost-effectiveness of screening women at high risk of breast cancer with magnetic resonance imaging, mammography and ultrasound - Kaiser, Clemens G.; Dietzel, Matthias; Vag, Tibor; Rübenthaler, Johannes; Froelich, Matthias F.; Tollens, Fabian (European Journal of Radiology, 2021)
Purpose: Aim of this study was to analyze the comparative cost-effectiveness of MR-mammography vs conventional imaging in a screening setting for women with high risk of breast cancer, with particular focus on the impact of specificity of MRM. Method: Decision analytic modelling and Markov Modelling were applied to evaluate cumulative costs of each screening modality and their subsequent treatments as well as cumulative outcomes in quality adjusted life years (QALYs). For the selected time horizon of 30 years, false positive and false negative results were included. Model input parameters for women with high risk of breast cancer were estimated based on published data from a US healthcare system perspective. Major influence factors were identified and evaluated in a deterministic sensitivity analysis. Based on current recommendations for economic evaluations, a probabilistic sensitivity analysis was conducted to test the model stability. Results: In a base-case analysis, screening with XM vs. MRM and treatment resulted in overall costs of 36,201.57 vs. 39,050.97 and a cumulative effectiveness of 19.53 QALYs vs. 19.59 QALYs. This led to an incremental cost-effectiveness ratio (ICER) of 45,373.94 per QALY for MRM. US and XM + US resulted in ICER values higher than the willingness to pay (WTP). In the sensitivity analyses, MRM remained a cost-effective strategy for screening high-risk patients as long as the specificity of MRM did not drop below 86.7 %. Conclusion: In high-risk breast cancer patients, MRM can be regarded as a cost-effective alternative to XM in a yearly screening setting. Specificity may be an important cost driver in settings with yearly screening intervals.
CRIS-Team Scopus Importer:2021-02-12
Keywords: Breast cancer; Clinical breast examination; High-Risk screening; Mammography; MR-Mammography; Ultrasound

IMPACT OF STATINS ON HEMATOMA CHARACTERISTICS, PERIHEMORRHAGIC EDEMA, SEIZURES AND FUNCTIONAL RECOVERY AFTER INTRACEREBRAL HEMORRHAGE - Sprügel, Maximilian; Kuramatsu, Joji; Volbers, Bastian; Sembill, Jochen; Saam, Justina; Gerner, Stefan; Balk, Stefanie; Hamer, Hajo; Lücking, Hannes; Hölter, Philip; Nolte, C.; Scheitz, J.; et al. (INTERNATIONAL JOURNAL OF STROKE, 2020)
CRIS-Team WoS Importer:2021-01-22

Impact of Statins on Hematoma, Edema, Seizures, Vascular Events, and Functional Recovery After Intracerebral Hemorrhage - Sprügel, Maximilian; Kuramatsu, Joji; Volbers, Bastian; Saam, Justina; Sembill, Jochen; Gerner, Stefan; Balk, Stefanie; Hamer, Hajo; Lücking, Hannes; Hölter, Philip; Nolte, Christian H.; Scheitz, Jan F.; et al. (Stroke, 2021)
BACKGROUND AND PURPOSE: The impact of statins on hematoma characteristics, perihemorrhagic edema (PHE), cardiovascular events, seizures, and functional recovery in patients with intracerebral hemorrhage (ICH) is insufficiently studied. METHODS: Patients with ICH of the prospective UKER-ICH (Universitätsklinikum Erlangen Cohort of Patients With Spontaneous Intracerebral Hemorrhage) study (URL: https://www.clinicaltrials.gov; Unique identifier: NCT03183167) were analyzed by multivariable regression modeling and propensity score matching, and PHE volumes were volumetrically assessed. Outcomes comprised hematoma characteristics, the impact of continuation, discontinuation, and initiation of statins on peak PHE extent, and the influence of statin treatment on the occurrence of seizures, cardiovascular adverse events, and functional recovery after ICH. RESULTS: A total of 1275 patients with ICH with information on statin treatment were analyzed. Statin treatment on hospital admission (21.7%) was associated with higher rates of lobar versus nonlobar ICH (odds ratio, 1.57 [1.03-2.40]; P=0.038). Initiation of statins after ICH was associated with increased peak PHE (β=0.12, SE=0.06, P=0.008), whereas continuation versus discontinuation of prior statin treatment was not significantly associated with edema formation (P>0.10). There were no significant differences in the incidence of remote symptomatic seizures according to statin exposure during follow-up (statins: 11.5% versus no statins: 7.8%, subdistribution hazard ratio: 1.15 [0.80-1.66]; P=0.512). Patients on statins revealed less cardiovascular adverse events and more frequently functional recovery after 12 months (functional recovery: 57.7% versus 45.0%, odds ratio 1.67 [1.09-2.56]; P=0.019). CONCLUSIONS: Among statin users, lobar ICH occurs more frequently as compared with nonstatin users. While continuation of prior statin treatment appears to be safe regarding PHE formation, the initiation of statins during the first days after ICH may increase PHE extent. However, statins should be initiated thereafter (eg, at hospital discharge) to prevent cardiovascular events and potentially improve functional recovery.
CRIS-Team Scopus Importer:2021-03-19
Keywords: edema; hematoma; incidence; odds ratio; seizures

Impact of velocity- and acceleration-compensated encodings on signal dropout and black-blood state in diffusion-weighted magnetic resonance liver imaging at clinical TEs - Führes, Tobit; Saake, Marc; Szczepankiewicz, Filip; Bickelhaupt, Sebastian; Uder, Michael; Laun, Frederik Bernd (PLoS ONE, 2023)
Purpose The study aims to develop easy-to-implement concomitant field-compensated gradient waveforms with varying velocity-weighting (M1) and acceleration-weighting (M2) levels and to evaluate their efficacy in correcting signal dropouts and preserving the black-blood state in liver diffusion-weighted imaging. Additionally, we seek to determine an optimal degree of compensation that minimizes signal dropouts while maintaining blood signal suppression. Methods Numerically optimized gradient waveforms were adapted using a novel method that allows for the simultaneous tuning of M1- and M2-weighting by changing only one timing variable. Seven healthy volunteers underwent diffusion-weighted magnetic resonance imaging (DWI) with five diffusion encoding schemes (monopolar, velocity-compensated (M1 = 0), acceleration-compensated (M1 = M2 = 0), 84%-M1–M2-compensated, 67%-M1–M2-compensated) at b-values of 50 and 800 s/mm2 at a constant echo time of 70 ms. Signal dropout correction and apparent diffusion coefficients (ADCs) were quantified using regions of interest in the left and right liver lobe. The blood appearance was evaluated using two five-point Likert scales. Results Signal dropout was more pronounced in the left lobe (19%-42% less signal than in the right lobe with monopolar scheme) and best corrected by acceleration-compensation (8%-10% less signal than in the right lobe). The black-blood state was best with monopolar encodings and decreased significantly (p < 0.001) with velocity- and/or acceleration-compensation. The partially M1–M2-compensated encoding schemes could restore the black-blood state again. Strongest ADC bias occurred for monopolar encodings (difference between left/right lobe of 0.41 μm2/ms for monopolar vs. < 0.12 μm2/ms for the other encodings). Conclusion All of the diffusion encodings used in this study demonstrated suitability for routine DWI application. The results indicate that a perfect value for the level of M1–M2-compensation does not exist. However, among the examined encodings, the 84%-M1–M2-compensated encodings provided a suitable tradeoff.
CRIS-Team Scopus Importer:2023-10-20

Impairment of the Visual System in Glaucoma - Schmidt, Manuel; Engelhorn, Tobias; Dörfler, Arnd; Michelson, Georg (Klinische Monatsblätter für Augenheilkunde, 2019)
MR Diffusion Tensor Imaging (DTI) enables visualisation of the visual system in glaucoma; it has been shown that the atrophy of the optic radiation is more pronounced in glaucoma than in age-matched controls. The atrophy of the optic radiation thereby correlates with OCT and visual field measures. Diffusion tensor imaging permits quantification of the axonal integrity of the optic radiation by calculation of fractional anisotropy (FA) and radial diffusivity (RD). Both within and also outside the visual system, there are substantial changes in FA and RD, changes suggesting a complex neurodegenerative disease. Metabolic MRI by specific Na+-coils and by the CEST-technique (CEST: chemical exchange saturation transfer) will enable visualisation of neuronal cell death and pathological protein accumulation in the visual system. It is proposed that glaucomatous atrophy of the visual system may be induced by antero- and retrograde axonal degeneration. In normal tension glaucoma and PEX glaucoma, retrograde degeneration is induced by ischemic lesions or pathological protein accumulation within the cerebral portion of the visual system. Magnetic resonance imaging of the visual system with DTI and metabolic imaging will potentially improve therapeutic monitoring and diagnosis of glaucoma.
CRIS-Team WoS Importer:2019-03-06

Implementation of a dedicated 1.5 T MR scanner for radiotherapy treatment planning featuring a novel high-channel coil setup for brain imaging in treatment position - Mengling, Veit; Bert, Christoph; Perrin, Rosalind; Masitho, Siti; Weissmann, Thomas; Mansoorian, Sina; Siavooshhaghighi, Hadi; Janka, Rolf Matthias; Doussin, Sylvain; Habatsch, Melanie; Fietkau, Rainer; Putz, Florian (Strahlentherapie und Onkologie, 2020)
Purpose: To share our experiences in implementing a dedicated magnetic resonance (MR) scanner for radiotherapy (RT) treatment planning using a novel coil setup for brain imaging in treatment position as well as to present developed core protocols with sequences specifically tuned for brain and prostate RT treatment planning. Materials and methods: Our novel setup consists of two large 18-channel flexible coils and a specifically designed wooden mask holder mounted on a flat tabletop overlay, which allows patients to be measured in treatment position with mask immobilization. The signal-to-noise ratio (SNR) of this setup was compared to the vendor-provided flexible coil RT setup and the standard setup for diagnostic radiology. The occurrence of motion artifacts was quantified. To develop magnetic resonance imaging (MRI) protocols, we formulated site- and disease-specific clinical objectives. Results: Our novel setup showed mean SNR of 163 ± 28 anteriorly, 104 ± 23 centrally, and 78 ± 14 posteriorly compared to 84 ± 8 and 102 ± 22 anteriorly, 68 ± 6 and 95 ± 20 centrally, and 56 ± 7 and 119 ± 23 posteriorly for the vendor-provided and diagnostic setup, respectively. All differences were significant (p > 0.05). Image quality of our novel setup was judged suitable for contouring by expert-based assessment. Motion artifacts were found in 8/60 patients in the diagnostic setup, whereas none were found for patients in the RT setup. Site-specific core protocols were designed to minimize distortions while optimizing tissue contrast and 3D resolution according to indication-specific objectives. Conclusion: We present a novel setup for high-quality imaging in treatment position that allows use of several immobilization systems enabling MR-only workflows, which could reduce unnecessary dose and registration inaccuracies.
CRIS-Team Scopus Importer:2020-10-30
Keywords: Immobilization; MR-only treatment planning; Prostate; Simulation; Stereotactic radiosurgery

Implementation of machine learning into clinical breast MRI: Potential for objective and accurate decision-making in suspicious breast masses - Ellmann, Stephan; Wenkel, Evelyn; Dietzel, Matthias; Bielowski, Christian; Vesal, Sulaiman; Maier, Andreas; Hammon, Matthias; Janka, Rolf Matthias; Fasching, Peter; Beckmann, Matthias; Schulz-Wendtland, Rüdiger; Uder, Michael; et al. (PLoS ONE, 2020)
We investigated whether the integration of machine learning (ML) into MRI interpretation can provide accurate decision rules for the management of suspicious breast masses. A total of 173 consecutive patients with suspicious breast masses upon complementary assessment (BI-RADS IV/V: n = 100/76) received standardized breast MRI prior to histological verification. MRI findings were independently assessed by two observers (R1/R2: 5 years of experience/no experience in breast MRI) using six (semi-)quantitative imaging parameters. Interobserver variability was studied by ICC (intraclass correlation coefficient). A polynomial kernel function support vector machine was trained to differentiate between benign and malignant lesions based on the six imaging parameters and patient age. Ten-fold cross-validation was applied to prevent overfitting. Overall diagnostic accuracy and decision rules (rule-out criteria) to accurately exclude malignancy were evaluated. Results were integrated into a web application and published online. Malignant lesions were present in 107 patients (60.8%). Imaging features showed excellent interobserver variability (ICC: 0.81–0.98) with variable diagnostic accuracy (AUC: 0.65–0.82). Overall performance of the ML algorithm was high (AUC = 90.1%; BI-RADS IV: AUC = 91.6%). The ML algorithm provided decision rules to accurately rule-out malignancy with a false negative rate <1% in 31.3% of the BI-RADS IV cases. Thus, integration of ML into MRI interpretation can provide objective and accurate decision rules for the management of suspicious breast masses, and could help to reduce the number of potentially unnecessary biopsies.<br

Imported tropical fish causes ciguatera fish poisoning in Germany - Zimmermann, Katharina; Eisenblätter, Anneka; Vetter, Irina; Ebbecke, Martin; Friedemann, Miriam; Desel, Herbert (Deutsche Medizinische Wochenschrift, 2015)
Ciguatera is a seafood-borne illness caused by consumption of tropical fish contaminated with ciguatoxins, lipophilic polyethers that are produced in benthic dinoflagellates and accumulate through the marine food chain. Ciguatera cases in Europe usually occur in travellers returning from tropical and subtropical regions of the Pacific and Carribean, where ciguatera is endemic. In 2012, several cases of ciguatera occurred in Germany due to sale of contaminated fish products originating from the Indian Ocean. Although the symptomatology in these cases were typical of ciguatera, with patients reporting gastrointestinal discomfort including nausea, vomiting and diarrhea as well as neurological effects including widespread intense pruritus, paresthesias, hypothermia or altered temperature sensation and diffuse pain, correct diagnosis was delayed in all cases due to lack of awareness of the treating medical practitioners. In light of increasing global mobility, trade, and occurrence of ciguatoxic fish in previously non-endemic areas, ciguatera should be considered as a possible diagnosis if gastrointestinal and neurological symptoms occur shortly after consumption of fish.
EVALuna2:2486

Improved Detection of Cavernous Sinus Invasion of Pituitary Macroadenomas with Ultra-High-Field 7 T MRI - Eisenhut, Felix; Schmidt, Manuel; Buchfelder, Michael; Dörfler, Arnd; Schlaffer, Sven-Martin (Life, 2023)
To compare 7 T magnetic resonance imaging (MRI) of pituitary macroadenomas (PMA) with standard MRI and intraoperative findings regarding tumor detection, localization, size, and extension. Patients with suspected pituitary adenoma underwent pre-operative 1.5 T or 3 T and 7 T MRI; 14 patients with a PMA were included. A qualitative (lesion detection, location, cavernous sinus infiltration) and quantitative (lesion size, depth of cavernous sinus infiltration) analysis of 1.5 T, 3 T and 7 T MRI was performed and compared with intraoperative findings. Both 1.5/3 T and 7 T MRI enabled the detection of all PMAs; lesion size determination was equal. 7 T MRI enables more precise assessments of cavernous sinus infiltration of PMA (ncorrect 7T = 78.6%, ncorrect 1.5/3T = 64.3%). Ultra-high-field MRI is a reliable imaging modality for evaluation of PMAs providing exact information on lesion location and size. 7 T MRI yielded more accurate information on cavernous sinus infiltration with better agreement with intraoperative findings than standard MRI.
CRIS-Team Scopus Importer:2023-01-27
Keywords: cavernous sinus infiltration; intraoperative findings; pituitary macroadenoma; ultra-high-field MRI

Improved Image Quality in Head and Neck CT Using a 3D Iterative Approach to Reduce Metal Artifact - Wüst, Wolfgang; May, Matthias; Brand, Michael; Bayerl, N.; Krauss, A.; Uder, Michael; Lell, Michael (American Journal of Neuroradiology, 2015)
Metal artifacts from dental fillings and other devices degrade image quality and may compromise the detection and evaluation of lesions in the oral cavity and oropharynx by CT. The aim of this study was to evaluate the effect of iterative metal artifact reduction on CT of the oral cavity and oropharynx.Data from 50 consecutive patients with metal artifacts from dental hardware were reconstructed with standard filtered back-projection, linear interpolation metal artifact reduction (LIMAR), and iterative metal artifact reduction. The image quality of sections that contained metal was analyzed for the severity of artifacts and diagnostic value.A total of 455 sections (mean ± standard deviation, 9.1 ± 4.1 sections per patient) contained metal and were evaluated with each reconstruction method. Sections without metal were not affected by the algorithms and demonstrated image quality identical to each other. Of these sections, 38% were considered nondiagnostic with filtered back-projection, 31% with LIMAR, and only 7% with iterative metal artifact reduction. Thirty-three percent of the sections had poor image quality with filtered back-projection, 46% with LIMAR, and 10% with iterative metal artifact reduction. Thirteen percent of the sections with filtered back-projection, 17% with LIMAR, and 22% with iterative metal artifact reduction were of moderate image quality, 16% of the sections with filtered back-projection, 5% with LIMAR, and 30% with iterative metal artifact reduction were of good image quality, and 1% of the sections with LIMAR and 31% with iterative metal artifact reduction were of excellent image quality.Iterative metal artifact reduction yields the highest image quality in comparison with filtered back-projection and linear interpolation metal artifact reduction in patients with metal hardware in the head and neck area.
EVALuna2:14480

Improved T*₂ determination in 23Na, 35Cl, and 17O MRI using iterative partial volume correction based on 1H MRI segmentation - Niesporek, Sebastian C.; Umathum, Reiner; Fiedler, Thomas M.; Bachert, Peter; Ladd, Mark E.; Nagel, Armin Michael (Magnetic Resonance Materials in Physics Biology and Medicine, 2017)
OBJECTIVE: Functional parameters can be measured with the help of quantitative non-proton MRI where exact relaxometry parameters are needed. Investigation of [Formula: see text] is often biased by strong partial volume (PV) effects. Hence, in this work a PV correction algorithm approach was evaluated that uses iteratively adapted [Formula: see text]-values and high-resolution structural 1H data to determine transverse relaxation in non-proton MRI more accurately. MATERIALS AND METHODS: Simulations, a phantom study and in vivo 23Na, 17O and 35Cl MRI measurements of five healthy volunteers were performed to evaluate the algorithm. [Formula: see text] values of grey matter (GM), white matter (WM) and cerebrospinal fluid (CSF) were obtained. Data were acquired at B 0 = 7T with nominal spatial resolutions of (4-7 mm)3 using a density-adapted radial sequence. The resulting transverse relaxation times were used for quantification of 17O data. RESULTS: The conducted simulations and phantom study verified the correction performance of the algorithm. For in vivo measured [Formula: see text] values, the correction of PV effects leads to an increase in CSF and to a decrease in GM/WM (23Na MRI: long/short GM, WM [Formula: see text]: 36.4 ± 3.1/5.4 ± 0.2, 23.3 ± 2.6/3.5 ± 0.1 ms; 35Cl MRI: 8.9 ± 1.4/1.0 ± 0.4, 5.9 ± 0.3/0.4 ± 0.1 ms; 17O MRI: 2.5 ± 0.1, 2.8 ± 0.1 ms). Iteratively corrected in vivo [Formula: see text] values of the 17O study resulted in improved water content quantification. CONCLUSION: The proposed iterative algorithm for PV correction leads to more accurate [Formula: see text] values and, thus, can improve accuracy in quantitative non-proton MRI.
EVALuna2:36101

Improved visualization of peripherally inserted central catheters on chest radiographs of neonates using fractional multiscale image processing - Hammon, Rebecca A.; Seuß, Hannes; Hammon, Matthias; Grillhoesl, Christian; Heiß, Rafael; Zeilinger, Martin; Bayerl, Nadine; Vuylsteke, Pieter; Wanninger, Friedrich; Schroth, Michael; Uder, Michael; Rompel, Oliver (BMC Medical Imaging, 2019)
BACKGROUND: Peripherally inserted central catheters (PICCs) provide secure intravenous access for the delivery of life-sustaining medications and nutrition. They are commonly used in pediatrics. Confirmation of correct central catheter tip position is crucial. Verification is usually done by a radiograph. The aim of this study is to evaluate the ability of Fractional Multiscale image Processing (FMP) to detect PICC tips on the digital chest radiographs of neonates. METHODS: A total of 94 radiographs of 47 patients were included in the study. 29 patients were male, 18 were female. The mean age of all examined children was 9.2 days (range 0-99 days). In total, six readers (two radiologists, two residents in radiology, one last year medical student, one neonatologist) evaluated 94 unprocessed and catheter-enhanced radiographs using a 5-point Likert scale (1 = poor catheter tip visualization, 5 = excellent catheter tip visualization). Additionally, the two radiologists evaluated the diagnostic confidence for chest pathologies using a 5-point Likert scale (1 = poor diagnostic confidence, 5 = excellent diagnostic confidence). Radiographs were evaluated on a dedicated workstation. RESULTS: In all cases, the catheter-enhanced radiograph rated higher than (n = 471), or equal (n = 93) to, the unprocessed radiograph when visualizing catheter tips. 87% of the catheter-enhanced radiographs obtained a rating of 4 or higher, while only 42% of unprocessed radiographs received 4 or more points. Regarding diagnostic confidence for chest pathologies one radiologist rated two catheter-enhanced radiographs higher than the unprocessed radiographs, while all other 186 evaluations rated the catheter-enhanced radiographs equal to (n = 78) or lower than (n = 108) the unprocessed radiographs. Only 60% of the catheter-enhanced radiographs yielded a diagnostic confidence of 4 or higher, while 90% of the unprocessed images received 4 or more points. CONCLUSION: Catheter-enhanced digital chest radiographs demonstrate improved visualization of low contrast PICC tips in neonates compared to unprocessed radiographs. Furthermore, they enable detection of accompanying chest pathologies. However, definitive diagnosis of chest pathologies should be made on unprocessed radiographs.
EVALuna2:36095

Improved Visualization of Prostate Cancer Using Multichannel Computed Diffusion Images: Combining ADC and DWI - Hammon, Matthias; Saake, Marc; Laun, Frederik Bernd; Heiß, Rafael; Seuss, Nicola; Janka, Rolf Matthias; Cavallaro, Alexander Josef; Uder, Michael; Seuß, Hannes (Diagnostics, 2022)
(1) Background: For the peripheral zone of the prostate, diffusion weighted imaging (DWI) is the most important MRI technique; however, a high b-value image (hbDWI) must always be evaluated in conjunction with an apparent diffusion coefficient (ADC) map. We aimed to unify the important contrast features of both a hbDWI and ADC in one single image, termed multichannel computed diffusion images (mcDI), and evaluate the values of these images in a retrospective clinical study; (2) Methods: Based on the 2D histograms of hbDWI and ADC images of 70 patients with histologically proven prostate cancer (PCa) in the peripheral zone, an algorithm was designed to generate the mcDI. Then, three radiologists evaluated the data of 56 other patients twice in three settings (T2w images +): (1) hbDWI and ADC; (2) mcDI; and (3) mcDI, hbDWI, and ADC. The sensitivity, specificity, and inter-reader variability were evaluated; (3) Results: The overall sensitivity/specificity were 0.91/0.78 (hbDWI + ADC), 0.85/0.88 (mcDI), and 0.97/0.88 (mcDI + hbDWI + ADC). The kappa-values for the inter-reader variability were 0.732 (hbDWI + ADC), 0.800 (mcDI), and 0.853 (mcDI + hbDWI + ADC). (4) Conclusions: By using mcDI, the specificity of the MRI detection of PCa was increased at the expense of the sensitivity. By combining the conventional diffusion data with the mcDI data, both the sensitivity and specificity were improved.
CRIS-Team WoS Importer:2022-08-12

Improvement of albuminuria after renal denervation - Ott, Christian; Mahfoud, Felix; Schmid, Axel; Ditting, Tilmann; Veelken, Roland; Ewen, Sebastian; Ukena, Christian; Uder, Michael; Boehm, Michael; Schmieder, Roland (International Journal of Cardiology, 2014)
The primary objective of this study was the effect of renal denervation (RDN) on elevated urinary albumin-to-creatinine ratio (UACR) in treatment-resistant hypertensive patients. In addition, patients were stratified according their UACR at baseline into micro- (30-300 mg/g, n=37) and macroalbuminuria (>= 300 mg/g, <2,200 mg/g, n=22).Increased albuminuria indicates cardiovascular and renal damage in hypertension. RDN emerged as an innovative interventional approach to reduce blood pressure (BP) and may thus reduce albumin urinary excretion.Fifty-nine treatment-resistant hypertensive patients with elevated UACR at baseline underwent catheter-based RDN using the Symplicity Flex(TM) catheter (Medtronic Inc., Santa Rosa, CA).In the whole and pre-specified subgroups both office and 24-h ambulatory BP were significantly reduced 6 months after RDN. In parallel, a significant reduction in UACR occurred in all patients (160 (65-496) versus 89 (29-319) mg/g creatinine, p<0.001) and in both subgroups (microalbuminuria: 83 (49-153) versus 58 (17-113) mg/g creatinine, p=0.001; macroalbuminuria: (536 (434-1483) versus 478 (109-1080) mg/g creatinine, p<0.001). In accordance, the prevalence of micro- and macroalbuminuria decreased significantly. Regression analysis revealed a modest positive relationship between the decrease of UACR and the fall of systolic BP (?=0.340, p=0.039) independent of renal function. Renal function remained unchanged after RDN.In summary, following RDN, the magnitude of albuminuria as well as the prevalence of micro- and macroalbuminuria decreased in treatment-resistant hypertensive patients. Since albuminuria is an independent renal and cardiovascular risk factor, our findings suggest a reduction of renal and cardiovascular risk in these patients.
EVALuna2:3681

Improvement of Deep Learning-based Auto-detection of Brain Metastases by Integrating previous MRI Images - Dörfler, Arnd; Huang, Yixing; Bert, Christoph; Sommer, Philipp; Frey, Benjamin; Gaipl, Udo; Distel, Luitpold; Weissmann, Thomas; Uder, Michael; Schmidt, Manuel; Maier, Andreas; Fietkau, Rainer; et al. (STRAHLENTHERAPIE UND ONKOLOGIE, 2022)
CRIS-Team WoS Importer:2022-06-03

Improving Contrast Enhancement in Pulmonary CTA: The value of breathing maneuvers - Manava, P.; Galster, M.; Schoen, M.; Ficker, J.; Lell, Michael; Adamus, R.; Bruch, M. (European Journal of Radiology Open, 2020)
Purpose: To investigate contrast dynamics and artifacts associated with different breathing maneuvers during pulmonary computed tomography angiography (pCTA) in a prospective randomized clinical trial. Method: Three different breathing maneuvers (inspiration, expiration, Mueller) were randomly assigned to 146 patients receiving pCTA for suspected pulmonary embolism (PE). Contrast enhancement of central and peripheral arteries and imaging quality of lung parenchyma were compared and analyzed. Results were compared by using the analysis of variances (ANOVA) and Kruskal-Wallis-Test. Results: Mean enhancement in the pulmonary trunk was highest during breath-hold in inspiration (293 HU, range 195–460 HU) compared to Mueller (259 HU, range 136–429 HU, p = 0022) and expiration (267 HU, range 115–376 HU). This was similar for the right pulmonary artery (inspiration 289 HU, range 173–454 HU; Mueller 250 HU, range 119–378 HU; p = 0.007; expiration 257 HU, range 114–366 HU; p = 0.032) and left pulmonary artery (inspiration 280.3 HU, range 170–462 HU; Mueller 245 HU, range 111–371 HU; p = 0.016; expiration 252 HU, range 110–371 HU). Delineation of peripheral arteries was significantly better in inspiration vs Mueller (p = 0.006) and expiration (p = 0.049). Assessment of the lung parenchyma was significantly better in inspiration vs Mueller (p = 0.013) or expiration (p < 0.001). Conclusions: Resting inspiratory position achieved the highest enhancement levels in central and peripheral pulmonary arteries and best image quality of the pulmonary parenchyma in comparison to other breathing maneuvers. It is necessary to train the maneuver prior to the examination in order to avoid deep inspiration with the risk of suboptimal opacification of the pulmonary arteries.
CRIS-Team Scopus Importer:2020-10-23
Keywords: Breathing; Computed tomography angiography; Contrast density; Image quality; Pulmonary arteries; Pulmonary embolism

Improving diagnostic accuracy in assessing pulmonary edema on bedside chest radiographs using a standardized scoring approach - Hammon, Matthias; Dankerl, Peter; Voit-Hoehne, Heinz Leonhard; Sandmair, Martin; Kammerer, Ferdinand Josef; Uder, Michael; Janka, Rolf Matthias (BMC Anesthesiology, 2014)
To assess the value of a score-based system which allows standardized evaluation of pulmonary edema on bedside chest radiographs (CXRs) under routine clinical conditions.Seven experienced readers assessed bedside CXRs of ten patients with an extravascular lung water (EVLW)-value of <= 8 mL/kg (range: 4-8 mL/kg; indicates no pulmonary edema) and a series of ten patients with an EVLW-value of >= 15 mL/kg (range: 15-21 mL/kg; = indicates a pulmonary edema) with and without customized software which would permit a standardized assessment of the various indications of pulmonary edema. The software provides a score that identifies patients with and without pulmonary edema. EVLW-values were measured instantly after bedside CXR imaging using a pulse contour cardiac output (PiCCO) system and served as a reference standard. The patients were non-traumatic and not treated with diuretics or dobutamine during bedside CXR imaging and the PiCCO measurements. Mean sensitivity, specificity, positive and negative predictive value, the percentage of overall agreement and the free-marginal multirater kappa value was calculated for both the standard and the standardized score-based approach. The net reclassification index was calculated for each reader as well as for all readers.Evaluation of bedside CXRs by means of the score-based approach took longer (23 ± 12 seconds versus 7 ± 3 seconds without the use of the software) but improved radiologists' sensitivity (from 57 to 77%), specificity (from 90 to 100%) and the free-marginal multirater kappa value (from 0.34 to 0.68). The positive predictive value was raised from 85 to 100% and the negative predictive value from 68 to 81%. A net reclassification index of 0.3 (all readers) demonstrates an improvement in prediction performance gained by the score-based approach. The percentage of overall agreement was 67% with the standard approach and 84% with the software-based approach.The diagnostic accuracy of bedside CXRs to discriminate patients with elevated EVLW-values from those with a normal value can be improved with the use of a standardized score-based approach. The investigated system is freely available as a web-based application (accessible via: http://www.radiologie.uk-erlangen.de/aerzte-und-zuweiser/edema).
EVALuna2:14366

Improving the Safety of DIEP Flap Transplantation: Detailed Perforator Anatomy Study Using Preoperative CTA† - Frank, Katharina; Stroebel, Armin; Ludolph, Ingo; Hauck, Theresa; May, Matthias; Beier, Justus; Horch, Raymund E.; Arkudas, Andreas (Journal of Personalized Medicine, 2022)
Background: Deep inferior epigastric perforator and muscle sparing transverse rectus abdominis muscle flaps are commonly used flaps for autologous breast reconstruction. CT-angiography allows to analyse the perforator course preoperatively. Our aim was to compare the different aspects of perforator anatomy in the most detailed study. Methods: CT-angiographies of 300 female patients with autologous breast reconstruction of 10 years were analysed regarding the anatomy of the deep inferior epigastric artery and every perforator. Results: Overall, 2260 perforators were included. We identified correlations regarding the DIEA branching point and number of perforators and their intramuscular course. The largest perforator emerged more often from the medial branch of the DIEA than the smaller perforators (70% (416/595) vs. 54% (878/1634), p < 0.001) and more often had a direct connection to the SIEV (large 67% (401/595) vs. small 39% (634/1634), p < 0.01). Medial row perforators were larger than the laterals (lateral 1.44 mm ± 0.43 (n = 941) vs. medial 1.58 mm ± 0.52 (n = 1304) (p < 0.001)). The larger and more medial the perforator, the more likely it was connected to the SIEV: perforators with direct connection to the SIEV had a diameter of 1.65 mm ± 0.53 (n = 1050), perforators with indirect connection had a diameter of 1.43 ± 0.43 (n = 1028), perforators without connection had a diameter of 1.31 mm ± 0.37 (n = 169) (p < 0.001). Medial perforators were more often directly connected to the SIEV than lateral perforators (medial 56% (723/1302) vs. lateral 35% (327/941), p < 0.001). A lateral perforator more often had a short intramuscular course than medial perforators (69% (554/800) vs. 45% (474/1055), p < 0.001), which was also more often observed in the case of a small perforator and a caudal exit of the rectus sheath. Conclusion: The largest perforator emerges more often from the medial branch of the DIEA and frequently has a direct connection to the SIEV, making medial row perforators ideal for DIEP flap transplantation.
CRIS-Team Scopus Importer:2022-06-10
Keywords: autologous breast reconstruction; CTA; DIEP flap; MS-TRAM flap; perforator

Incidence, temporal profile and neuroanatomic correlates of poststroke epilepsy - Winder, Klemens; Bobinger, Tobias; Seifert, Frank; Mrochen, Anne; Haupenthal, David; Knott, Michael; Dörfler, Arnd; Hilz, Max-Josef; Schwab, Stefan; Fröhlich, Kilian (Journal of Neuroimaging, 2023)
Background and Purpose: The relationship between ischemic stroke site and occurrence of poststroke epilepsy (PSE) is incompletely understood. This study intended to evaluate incidence and temporal profiles of seizures and to correlate ischemic lesion sites with PSE using voxel-based lesion symptom mapping (VLSM). Methods: Patients with imaging-confirmed first-ever ischemic stroke without prior history of epilepsy were prospectively included. Demographic data, cardiovascular risk factors, and National Institute of Health Stroke Scale (NIHSS) scores were assessed. Data on seizures and modified Rankin scale scores were determined within a 90-day period after stroke onset. Ischemic lesion sites were correlated voxel wise with occurrence of PSE using nonparametric permutation test. Age- and sex-matched patients with first-ever ischemic strokes without PSE after 90 days served as controls for the VLSM analysis. Results: The stroke database contained 809 patients (mean age: 68.4 ± 14.2 years) with first-ever imaging-confirmed ischemic strokes without history of epilep. Incidence of PSE after 90-day follow-up was 2.8%. Five additional patients were admitted to the emergency department with a seizure after 90-day follow-up. Fifty percent of the seizures occurred in the acute phase after stroke. PSE patients had higher NIHSS scores and infarct volumes compared to controls without PSE (p <.05). PSE patients had infarcts predominantly involving the cerebral cortex. The hemisphere-specific VLSM analysis shows associations between PSE and damaged voxels in the left-hemispheric temporo-occipital transition zone. Conclusions: The data indicate that PSE occurs in a small proportion of patients with rather large ischemic strokes predominantly involving the cerebral cortex. Especially patients with ischemic lesions in the temporo-occipital cortex are vulnerable to develop PSE.
CRIS-Team Scopus Importer:2023-05-19
Keywords: ischemic stroke; poststroke epilepsy; voxel-based lesion symptom mapping

Increased microcirculation detected by dynamic contrast-enhanced magnetic resonance imaging is of prognostic significance in asymptomatic myeloma - Hillengass, Jens; Ritsch, Judith; Merz, Maximilian; Wagner, Barbara; Kunz, Christina; Hielscher, Thomas; Laue, Hendrik; Bäuerle, Tobias; Zechmann, Christian M.; Ho, Anthony D.; Schlemmer, Heinz-Peter; Goldschmidt, Hartmut; et al. (British Journal of Haematology, 2016)
This prospective study aimed to investigate the prognostic significance of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) as a non-invasive imaging technique delivering the quantitative parameters amplitude A (reflecting blood volume) and exchange rate constant kep (reflecting vascular permeability) in patients with asymptomatic monoclonal plasma cell diseases. We analysed DCE-MRI parameters in 33 healthy controls and 148 patients with monoclonal gammopathy of undetermined significance (MGUS) or smouldering multiple myeloma (SMM) according to the 2003 IMWG guidelines. All individuals underwent standardized DCE-MRI of the lumbar spine. Regions of interest were drawn manually on T1-weighted images encompassing the bone marrow of each of the 5 lumbar vertebrae sparing the vertebral vessel. Prognostic significance for median of amplitude A (univariate: P < 0·001, hazard ratio (HR) 2·42, multivariate P = 0·02, HR 2·7) and exchange rate constant kep (univariate P = 0·03, HR 1·92, multivariate P = 0·46, HR 1·5) for time to progression of 79 patients with SMM was found. Patients with amplitude A above the optimal cut-off point of 0·89 arbitrary units had a 2-year progression rate into symptomatic disease of 80%. In conclusion, DCE-MRI parameters are of prognostic significance for time to progression in patients with SMM but not in individuals with MGUS.
EVALuna2:14624

Increased midbrain sodium levels in progressive supranuclear palsy - Prasuhn, J.; Goettlich, M.; Grosser, S.; Reuther, K.; Ebeling, B.; Bodemann, C.; Hanssen, H.; Nagel, Armin Michael; Bruggemann, N. (EUROPEAN JOURNAL OF NEUROLOGY, 2022)
CRIS-Team WoS Importer:2022-07-22

Increased Neutrophil-to-Lymphocyte Ratio is Associated with Unfavorable Functional Outcome in Acute Ischemic Stroke - Giede-Jeppe, Antje; Madzar, Dominik; Sembill, Jochen; Sprügel, Maximilian; Atay, Selim; Lücking, Hannes; Huttner, Hagen; Bobinger, Tobias; Hölter, Philip (Neurocritical Care, 2019)
Background Inflammatory response is the hallmark of secondary brain injury in stroke patients. Neutrophil-to-lymphocyte ratio (NLR) emerged as a marker for functional outcome in several diseases. Objectives To investigate the association between NLR on admission and during hospital stay and functional outcome in acute ischemic stroke (AIS). Methods This observational study included all consecutive AIS patients admitted at a German stroke center covering 2011-2013. Patient characteristics and clinical data were retrieved from institutional databases. Multivariate analysis was conducted to investigate parameters associated with functional outcome. Receiver operating characteristic (ROC) analysis was performed to identify the best cutoff for NLR to discriminate between favorable and unfavorable functional outcome. To account for imbalances in baseline characteristics, propensity score matching was carried out to assess the influence of NLR on functional outcome. Results A total of 807 patients with AIS were included for analysis. Patients with worse functional outcome at 3 months were older and had worse clinical status on admission, higher rates of infectious complications, and an increased NLR. ROC analysis identified a NLR of 3.3 as best cutoff value to discriminate between favorable and unfavorable functional outcomes (area under the curve 0.693, p < 0.001, Youden's index = 0.318; p < 0.001; sensitivity 68.5%, specificity 63.9%). Propensity-matched analysis still demonstrated a higher rate of unfavorable functional outcome at 3 months in patients with NLR >= 3.3 [modified Rankin scale 3-6 at 3 months: NLR >= 3.3 51.5% vs. NLR < 3.3 36.4%; p = 0.002]. Conclusions In AIS patients we identified NLR as an important predictor for unfavorable functional outcome.
CRIS-Team WoS Importer:2019-10-25

Increased risk for radiographic osteoarthritis features in young active athletes: a cross-sectional matched case-control study - Roemer, Frank; Jarraya, M.; Niu, J.; Silva, J. -R.; Frobell, R.; Guermazi, Ali (Osteoarthritis and Cartilage, 2015)
Prevalence data on radiographic osteoarthritis (ROA) in young active athletes is sparse. Aim was to assess in a matched case-control design the frequency of ROA in an athlete population and whether athlete status, gender, previous anterior cruciate ligament (ACL) surgery and age increase the odds for ROA.135 consecutive athletes (82% soccer players) 18-36 years old and 550 non-athletes aged-matched controls had knee radiography (Lyon-Schuss protocol) for assessment of subacute or chronic knee complaints. Patients with acute trauma or fractures were excluded. Radiographs were graded according to the Kellgren-Lawrence and OARSI grading schemes. In addition, medial and lateral intercondylar notch osteophytes were scored. We used logistic regression model to assess the association of ROA and specific radiographic OA features with athlete status, prior ACL surgery, gender and age, adjusting for each other.19.4% of patients were 18-22 years old, 26.4% were 23-27, 22.6% were 28-32, and 31.5% were 33-36 years old. 18.7% were female and 8.8% had previous ACL surgery. 8.5% had ROA and 6.0% had evidence of JSN. The adjusted odds ratios (aOR) for ROA were 2.8 (95% confidence interval 1.4, 5.5) for athletes, 7.0 (3.5, 13.9) for previous ACL surgery and 3.3 (1.2, 9.0) for age range 32-36. Athlete status significantly increased odds for tibiofemoral osteophytes [aOR 2.9 (1.6, 5.4)] and comparably for notch osteophytes [aOR 2.3 (1.1, 4.7)].Athlete status, higher age and previous ACL surgery increase the risk of ROA with surgery being the strongest risk factor.
EVALuna2:14546

Increased Subcortical Sodium Levels in Patients with Progressive Supranuclear Palsy - Prasuhn, Jannik; Göttlich, Martin; Grosser, Sinja S.; Reuther, Katharina; Ebeling, Britt; Bodemann, Christina; Hanssen, Henrike; Nagel, Armin Michael; Brüggemann, Norbert (Biomedicines, 2022)
Progressive supranuclear palsy (PSP) is a debilitating neurodegenerative disease characterized by an aggressive disease course. Total and intracellular-weighted sodium imaging (Na-23-MRI) is a promising method for investigating neurodegeneration in vivo. We enrolled 10 patients with PSP and 20 age- and gender-matched healthy control subjects; all study subjects underwent a neurological examination, whole-brain structural, and (total and intracellular-weighted) Na-23-MRI. Voxel-wise analyses revealed increased brainstem total sodium content in PSP that correlated with disease severity. The ROI-wise analysis highlighted additional sodium level changes in other regions implicated in the pathophysiology of PSP. Na-23-MRI yields substantial benefits for the diagnostic workup of patients with PSP and adds complementary information on the underlying neurodegenerative tissue changes in PSP.
CRIS-Team WoS Importer:2022-08-12

Individual Calculation of Effective Dose and Risk of Malignancy Based on Monte Carlo Simulations after Whole Body Computed Tomography - Kopp, Markus; Loewe, Tobias; Wüst, Wolfgang; Brand, Michael; Wetzl, Matthias; Nitsch, Wolfram; Schmidt, Daniela; Beck, Michael; Schmidt, Bernhard; Uder, Michael; May, Matthias (Scientific Reports, 2020)
Detailed knowledge about radiation exposure is crucial for radiology professionals. The conventional calculation of effective dose (ED) for computed tomography (CT) is based on dose length product (DLP) and population-based conversion factors (k). This is often imprecise and unable to consider individual patient characteristics. We sought to provide more precise and individual radiation exposure calculation using image based Monte Carlo simulations (MC) in a heterogeneous patient collective and to compare it to phantom based MC provided from the National Cancer Institute (NCI) as academic reference. Dose distributions were simulated for 22 patients after whole-body CT during Positron Emission Tomography-CT. Based on MC we calculated individual Lifetime Attributable Risk (LAR) and Excess Relative Risk (ERR) of cancer mortality. EDMC was compared to EDDLP and EDNCI. EDDLP (13.2 ± 4.5 mSv) was higher compared to EDNCI (9.8 ± 2.1 mSv) and EDMC (11.6 ± 1.5 mSv). Relative individual differences were up to −48% for EDMC and −44% for EDNCI compared to EDDLP. Matching pair analysis illustrates that young age and gender are affecting LAR and ERR significantly. Because of these uncertainties in radiation dose assessment automated individual dose and risk estimation would be desirable for dose monitoring in the future.
CRIS-Team Scopus Importer:2020-06-23

Inert macrocyclic Eu3+ complex with affirmative paraCEST features - Gambino, Tanja; Laura, Valencia; Perez-Lourido, Paulo; Esteban-Gomez, David; Zaiß, Moritz; Platas-Iglesias, Carlos; Angelovski, Goran (Inorganic Chemistry Frontiers, 2020)
We report on a macrocyclic platform based on an 18-membered macrocycle that forms kinetically highly inert paramagnetic complexes and possesses an excellent outlook for the development of bioresponsive paraCEST (paramagnetic chemical exchange saturation transfer) contrast agents. The investigated europium(III) chelate is non-hydrated and contains four amide groups, each possessing two paramagnetically shifted proton resonances distant from bulk water. The X-ray crystal structure and solution studies indicate that the metal ion is ten-coordinated, being directly bound to the six N atoms of the macrocycle and the four amide O atoms of the pendant arms. The complex presents an excellent inertness with respect to dissociation, being stable under a variety of harsh conditions, including highly acidic and basic media or elevated temperatures. The amide protons are in slow-to-intermediate exchange with bulk water, which gives rise to the generation of a strong CEST effect at low probe concentration and saturation powers (similar to 25% at 5 mM, B-1 = 5 mu T, 37 degrees C). We demonstrate the potential of this platform for mapping pH in its microenvironment and foresee potential for the development of diverse paraCEST probes and sensors.
CRIS-Team WoS Importer:2020-07-10

Infiltration patterns in monoclonal plasma cell disorders: correlation of magnetic resonance imaging with matched bone marrow histology - Andrulis, Mindaugas; Bäuerle, Tobias; Goldschmidt, Hartmut; Delorme, Stefan; Landgren, Ola; Schirmacher, Peter; Hillengass, Jens (European Journal of Radiology, 2014)
To investigate how plasma cell infiltration patterns detected by MRI match the plasma cell distribution in bone marrow biopsy.We assessed 50 patients with monoclonal plasma cell disorders of all clinical stages. MRI infiltration pattern was compared with matched BM histology from the same anatomic region.MRI revealed a minimal (n=11, 22%), focal (n=5, 10%), diffuse (n=14, 28%) and mixed (n=20, 40%) infiltration pattern. Diffuse MRI pattern was predominant in smoldering myeloma patients whereas the MRI patterns with "focal component" (i.e. focal and mixed) were most common in symptomatic myeloma (p<0.01). In histology an interstitial (n=13, 26%), nodular (n=23, 46%) and packed marrow (n=14, 28%) was found respectively. All three histological types of infiltration were observed in patients with diffuse and mixed MRI patterns. Minimal MRI pattern was found in all MGUS patients and was associated with an interstitial BM infiltration. In two patients with minimal MRI pattern an extensive micro-nodular BM infiltration was found in histology.Infiltration patterns in MRI represent different histological growth patterns of plasma cells, but the MRI resolution is not sufficient to visualize micro-nodular aggregates of plasma cells.
EVALuna2:14581

Influence of antithrombotic pre-treatment and time window on hemorrhagic complications of ivt in ischemic stroke - Macha, Kosmas; Hölter, Philip; Sembill, Jochen; Hock, Stefan; Siedler, Gabriela; Mühlen, Iris; Haupenthal, David; Schwab, Stefan; Kallmünzer, Bernd; Dörfler, Arnd (EUROPEAN JOURNAL OF NEUROLOGY, 2022)
CRIS-Team WoS Importer:2022-07-22

Influence of Artifact Corrections on MRI Signal Intensity Ratios for Assessment of Gadolinium Brain Retention - Saake, Marc; Hepp, Tobias; Schmidle, Alexandra; Wüst, Wolfgang; Heiß, Rafael; Dörfler, Arnd; Uder, Michael; Bäuerle, Tobias (Academic Radiology, 2019)
Rationale and Objectives: Differences in brain signal intensity ratios (SIRs) of deep brain nuclei in T1-weighted (T1w) magnetic resonance images were reported as an indicator of gadolinium brain retention. Variable methods of image reconstruction and inhomogeneity correction for T1w images exist, which might affect the accuracy of SIRs. The aim of our prospective study was to investigate the effect of flow artifact compensation (FAC) and intensity inhomogeneity correction (IIC) on the dentate nucleus-to-pons and globus pallidus-to-thalamus SIRs in study participants who had previously received multiple doses of gadobutrol. Materials and Methods: This study included 76 participants who received five or more gadobutrol-enhanced scans between 2007 and 2017. A control group of 25 participants without gadolinium-based contrast agent application in their patient history was included for comparison. Unenhanced brain magnetic resonance imaging including two T1w spin-echo sequences with and without FAC was performed in all participants. Both sequences were reconstructed with and without IIC. Images were assessed for flow artifacts and SIRs were calculated. Results: Using FAC, a lower proportion of participants had to be excluded from the final analysis of dentate nucleus-to-pons SIR due to flow artifacts (15% versus 46%, p < 0.001). Without IIC, a difference was found between the study and the control group for the dentate nucleus-to-pons ratio (p = 0.004), but not for the same sequence reconstructed with IIC (p = 0.29). For the globus pallidus-to-thalamus ratio, no difference was found between the study and control group. Conclusion: The application of an IIC algorithm has significant impact on brain nuclei SIRs for the assessment of gadolinium brain retention.
CRIS-Team Scopus Importer:2019-08-30
Keywords: Contrast Media; Gadolinium; Magnetic resonance imaging

Influence of Cardiac MR Imaging on DNA Double-Strand Breaks in Human Blood Lymphocytes - Brand, Michael; Ellmann, Stephan; Sommer, Matthias; May, Matthias; Eller, Achim; Wüst, Wolfgang; Engert, Christina; Achenbach, Stephan; Kuefner, Michael A.; Bäuerle, Tobias; Lell, Michael; Uder, Michael (Radiology, 2015)
To evaluate the ability of magnetic resonance (MR) imaging to induce deoxyribonucleic acid (DNA) damage in patients who underwent cardiac MR imaging in daily routine by using ?-H2AX immunofluorescence microscopy.This study complies with the Declaration of Helsinki and was performed according to local ethics committee approval. Informed patient consent was obtained. Blood samples from 45 patients (13 women, 32 men; mean age, 50.3 years [age range, 20-89 years]) were obtained before and after contrast agent-enhanced cardiac MR imaging. MR imaging-induced double-strand breaks (DSBs) were quantified in isolated blood lymphocytes by using immunofluorescence microscopy after staining the phosphorylated histone variant ?-H2AX. Twenty-nine patients were examined with a myocarditis protocol (group A), 10 patients with a stress-testing protocol (group B), and six patients with flow measurements and angiography (group C). Paired t test was performed to compare excess foci before and after MR imaging.The mean baseline DSB level before MR imaging and 5 minutes after MR imaging was, respectively, 0.116 DSB per cell ± 0.019 (standard deviation) and 0.117 DSB per cell ± 0.019 (P = .71). There was also no significant difference in DSBs in these subgroups (group A: DSB per cell before and after MR imaging, respectively, 0.114 and 0.114, P = .91; group B: DSB per cell before and after MR imaging, respectively, 0.123 and 0.124, P = .78; group C: DSB per cell before and after MR imaging, respectively, 0.114 and 0.115, P = .36).By using ?-H2AX immunofluorescence microscopy, no DNA DSBs were detected after cardiac MR imaging.
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Influence of Different Antioxidants on X-Ray Induced DNA Double-Strand Breaks (DSBs) Using ?-H2AX Immunofluorescence Microscopy in a Preliminary Study - Brand, Michael; Sommer, Matthias; Ellmann, Stephan; Wüst, Wolfgang; May, Matthias; Eller, Achim; Vogt, Sabine; Lell, Michael; Kuefner, Michael A.; Uder, Michael (PLoS ONE, 2015)
Radiation exposure occurs in X-ray guided interventional procedures or computed tomography (CT) and ?-H2AX-foci are recognized to represent DNA double-strand breaks (DSBs) as a biomarker for radiation induced damage. Antioxidants may reduce the induction of ?-H2AX-foci by binding free radicals. The aim of this study was to establish a dose-effect relationship and a time-effect relationship for the individual antioxidants on DSBs in human blood lymphocytes.Blood samples from volunteers were irradiated with 10 mGy before and after pre-incubation with different antioxidants (zinc, trolox, lipoic acid, ß-carotene, selenium, vitamin E, vitamin C, N-acetyl-L-cysteine (NAC) and Q 10). Thereby, different pre-incubation times, concentrations and combinations of drugs were evaluated. For assessment of DSBs, lymphocytes were stained against the phosphorylated histone variant ?-H2AX.For zinc, trolox and lipoic acid regardless of concentration or pre-incubation time, no significant decrease of ?-H2AX-foci was found. However, ß-carotene (15%), selenium (14%), vitamin E (12%), vitamin C (25%), NAC (43%) and Q 10 (18%) led to a significant reduction of ?-H2AX-foci at a pre-incubation time of 1 hour. The combination of different antioxidants did not have an additive effect.Antioxidants administered prior to irradiation demonstrated the potential to reduce ?-H2AX-foci in blood lymphocytes.
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Influence of different reconstruction parameters in the visualization of intracranial stents using C-arm flat panel CT angiography: experience in an animal model - Ott, Sabine; Struffert, Tobias; Saake, Marc; Gölitz, Philipp; Adamek, Edyta; Dörfler, Arnd (Acta Radiologica, 2016)
C-arm flat panel computed tomography angiography (CA-CTA) is a relatively new imaging modality. Consequently, knowledge about postprocessing parameters and their influence on image quality is still limited, especially for the visualization of implanted microstents.To optimize reconstruction parameters by evaluating the influence of these different parameters for CA-CTA visualization of microstents in an animal model.Eleven microstents were implanted within the left common carotid artery of 11 New Zealand white rabbits. Both CA-CTA, using intra-venous delivery of contrast material, and conventional digital subtraction angiography (DSA) was performed. CA-CTA datasets were reconstructed using three different image characteristics (normal, sharp, smooth). Two experienced neuroradiologists evaluated the image quality and performed measurements of inner and outer stent diameters as well as measurements of the lumen area.Stent deployment was performed successfully in all animals. Inter-observer correlation coefficient for all measurements was high (r = 0.87-0.92). Lumen area and inner stent diameter were significantly smaller in image characteristic "smooth" (P < 0.01) than in "sharp" and "normal". Outer stent diameter was larger in "smooth" than in "sharp" and "normal" (P < 0.01). Stent strut size was significantly wider using image characteristic "smooth". "Sharp" and "normal" compared best to DSA, with "sharp" providing the closest match to DSA measurements, with the trade-off of significantly more noise than in the "normal" reconstructions.The use of different image characteristics in the postprocessing of CA-CTA datasets has an influence on the visualization of implanted stents. Image characteristic "sharp" and "normal" compared best to DSA.
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Influence of Early Enteral Nutrition on Clinical Outcomes in Neurocritical Care Patients With Intracerebral Hemorrhage - Peng, Jianhua; Volbers, Bastian; Sprugel, Maximilian I.; Hölter, Philip; Engelhorn, Tobias; Jiang, Yong; Kuramatsu, Joji; Huttner, Hagen; Dörfler, Arnd; Schwab, Stefan; Gerner, Stefan (Frontiers in Neurology, 2021)
Objective: Early enteral nutrition (EEN) represents the current standard of care for patients treated in general intensive care units (ICU). Specific nutritional recommendations for patients receiving dedicated neurocritical care are not established. This study investigated associations of EEN with clinical outcomes for patients suffering from intracerebral hemorrhage treated at a neurological ICU (NICU).
CRIS-Team WoS Importer:2021-05-14

Influence of image contrasts and reconstruction methods on the classification of multiple sclerosis-like lesions in simulated sodium magnetic resonance imaging - Ruck, Laurent; Mennecke, Angelika; Wilferth, Tobias; Lachner, Sebastian; Müller, Max; Egger, Nico; Dörfler, Arnd; Uder, Michael; Nagel, Armin Michael (Magnetic Resonance in Medicine, 2022)
Purpose To evaluate the classifiability of small multiple sclerosis (MS)-like lesions in simulated sodium (Na-23) MRI for different Na-23 MRI contrasts and reconstruction methods. Methods Na-23 MRI and Na-23 inversion recovery (IR) MRI of a phantom and simulated brain with and without lesions of different volumes (V = 1.3-38.2 nominal voxels) were simulated 100 times by adding Gaussian noise matching the SNR of real 3T measurements. Each simulation was reconstructed with four different reconstruction methods (Gridding without and with Hamming filter, Compressed sensing (CS) reconstruction without and with anatomical H-1 prior information). Based on the mean signals within the lesion volumes of simulations with and without lesions, receiver operating characteristics (ROC) were determined and the area under the curve (AUC) was calculated to assess the classifiability for each lesion volume. Results Lesions show higher classifiability in Na-23 MRI than in Na-23 IR MRI. For typical parameters and SNR of a 3T scan, the voxel normed minimal classifiable lesion volume (AUC > 0.9) is 2.8 voxels for Na-23 MRI and 19 voxels for Na-23 IR MRI, respectively. In terms of classifiability, Gridding with Hamming filter and CS without anatomical H-1 prior outperform CS reconstruction with anatomical H-1 prior. Conclusion Reliability of lesion classifiability strongly depends on the lesion volume and the Na-23 MRI contrast. Additional incorporation of H-1 prior information in the CS reconstruction was not beneficial for the classification of small MS-like lesions in Na-23 MRI.
CRIS-Team WoS Importer:2022-11-25

Influence of iodinated contrast media on the activities of histamine inactivating enzymes diamine oxidase and histamine N-methyltransferase in vitro - Kuefner, M. A.; Feurie, J.; Petersen, J.; Uder, Michael; Schwelberger, H. G. (Allergologia Et Immunopathologia, 2014)
Iodinated contrast media can cause pseudoallergic reactions associated with histamine release in significant numbers of patients. To clarify whether these adverse reactions may be aggravated by a compromised histamine catabolism we asked if radiographic contrast agents in vitro inhibit the histamine inactivating enzymes diamine oxidase (DAO) and histamine N-methyltransferase (HMT).Nine iodinated contrast agents were tested in vitro. Following pre-incubation of purified porcine kidney DAO and recombinant human HMT with 0.1-10mM of the respective contrast medium (H2O and specific inhibitors of DAO and HMT as controls) enzyme activities were determined by using radiometric micro assays.None of the contrast media irrespective of their structure showed significant inhibition of the activities of DAO and HMT. Pre-incubation of the enzymes with specific inhibitors led to complete inhibition of the respective enzymatic activity.The iodinated contrast media tested in vitro did not exhibit inhibition of histamine converting enzymes at physiologically relevant concentrations. However due to the in vitro character of this study these results do not directly reflect the in vivo situation.
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Influence of irregular heart rhythm on radiation exposure, image quality and diagnostic impact of cardiac computed tomography angiography in 4,339 patients. Data from the German Cardiac Computed Tomography Registry - Korosoglou, Grigorios; Giusca, Sorin; Schmermund, Axel; Schneider, Steffen; Bruder, Oliver; Hausleiter, Joerg; Schroeder, Stephen; Leber, Alexander; Limbourg, Tobias; Gitsioudis, Gitsios; Rixe, Johannes; Zahn, Ralf; et al. (Journal of Cardiovascular Computed Tomography, 2018)
BACKGROUND: Coronary computed tomography angiography (coronary CTA) provides non-invasive evaluation of the coronary arteries with high precision for the detection of significant coronary artery disease (CAD). AIM: To investigate whether irregular heart rhythm including atrial fibrillation and premature beats during data acquisition influences (i) radiation and contrast media exposure, (ii) number of non-evaluable coronary segments and (iii) diagnostic impact of coronary CTA. METHODS: Twelve tertiary care centers with ≥64 slice CT scanners and ≥5 years of experience with cardiovascular imaging participated in this registry. Between 2009 and 2014, 4339 examinations were analysed in patients who underwent clinically indicated coronary CTA for suspected CAD. Clinical and epidemiologic data were gathered from all patients. In addition, clinical presentation, heart rate and rhythm during the scan, Agatston score, radiation and contrast media exposure and the diagnostic impact of coronary CTA were systematically analysed. RESULTS: Of 4339 patients in total, 260 (6.0%) had irregular heart rhythm, whereas the remaining 4079 (94.0%) had stable sinus rhythm. Patients with irregular heart rhythm were older (63.2 ± 12.5yrs versus 58.6 ± 11.4yrs. p < 0.001), exhibited a higher rate of pathologic stress tests before CTA (37.1% versus 26.1%, p < 0.01) and higher heart rates during CTA compared to those with sinus rhythm (62.5 ± 11.6bpm versus 58.9 ± 8.5bpm, p < 0.001). Both contrast media exposure and radiation exposure were significantly higher in patients with irregular heart rhythm (90 mL (95%CI = 80-110 mL) versus 80 mL (95%CI = 70-90 mL) and 6.2 mSv (95%CI = 2.5-11.7) versus 3.3 mSv (95%CI = 1.7-6.9), p < 0.001 for both). Coronary CTA excluded significant CAD less frequently in patients with irregular heart rhythm (32.9% versus 44.8%, p < 0.001). This was attributed to the higher rate of examinations with at least one non-diagnostic coronary segment in patients with irregular heart rhythm (10.8% versus 4.6%, p < 0.001). Subsequent invasive angiography could be avoided in 47.2% of patients with irregular heart rhythm compared to 52.9% of patients with sinus rhythm (p = NS), whereas downstream stress testing was recommended in 3.2% of patients with irregular heart rhythm versus 4.0% of patients with sinus rhythm (p = NS). CONCLUSION: A significant number of patients scheduled for coronary CTA have irregular heart rhythm in a real-world clinical setting. In such patients, heart rate during coronary CTA is higher, possibly resulting in (i) higher radiation and contrast agent exposure and (ii) more frequent coronary CTA examinations with at least one non-diagnostic coronary artery segment. However, this does not seem to lead to increased downstream stress testing or subsequent invasive procedures.
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Influence of irregular heart rhythm on radiation exposure, image quality and diagnostic impact of cardiac computed tomography angiography in 4,767 patients - Korosoglou, G.; Schmermund, A.; Schneider, S.; Giusca, S.; Gitsioudis, Gitsios; Bruders, O.; Hausleiter, J.; Schroeder, S.; Leber, A.; Rixe, J.; Katus, H. A.; Achenbach, Stephan; et al. (2017)
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Influence of Prior Nicotine and Alcohol Use on Functional Outcome in Patients after Intracerebral Hemorrhage - Sembill, Jochen; Sprügel, Maximilian; Gerner, Stefan; Beuscher, Vanessa D.; Giede-Jeppe, Antje; Stocker, Margarete; Lücking, Hannes; Kuramatsu, Joji; Huttner, Hagen; Hölter, Philip (Journal of Stroke and Cerebrovascular Diseases, 2018)
Background: The influence of prior nicotine or alcohol use (legal drug use [LDU]) on outcome measures after intracerebral hemorrhage (ICH) is insufficiently established. We investigated drug-specific associations with (1) neuroradiologic and clinical parameters and (2) functional long-term outcome after ICH. Methods: This observational cohort study analyzed consecutive spontaneous patients with ICH (n = 554) from our prospective institutional registry over a 5-year study period (January 2010 to December 2014). We compared no-LDU patients with LDU patients, and patients using only nicotine, only alcohol, or both. To account for baseline imbalances, we reanalyzed cohorts after propensity score matching. Results: Prevalence of prior LDU was 197 of 554 (35.6%), comprising 94 of 554 (17.0%) with only nicotine use, 33 of 554 (6.0%) with only alcohol use, and 70 of 554 (12.6%) with alcohol and nicotine use. LDU patients were younger (65 [56-73] versus 75 [67-82], P < .01), less often female (n = 61 of 197 [31.0%] versus n = 188 of 357 [52.7%], P < .01), had more often prior myocardial infarction (n = 29 of 197 [14.7%] versus n = 24 of 357 [6.7%], P < .01), and in-hospital complications (sepsis or systemic inflammatory response syndrome: n = 95 of 197 [48.2%] versus n = 98 of 357 [27.5%], P < .01; pneumonia: n = 89 of 197 [45.2%] versus n = 110 of 357 [30.8%], P < .01). Except for an increased risk of pneumonia (odds ratio 2.22, confidence interval [1.04-4.75], P = .04) in patients using both nicotine and alcohol, we detected no significant differences upon reanalysis after propensity score matching of neuroradiologic or clinical parameters, complications, or long-term outcome between patients with and without LDU (mortality: n = 48 of 150 [32.0%] versus n = 45 of 150 [30.0%], P = .71; favorable outcome [modified Rankin Scale 0-3]: n = 56 of 150 [37.3%] versus n = 53 of 150 [35.3%], P = .72). Conclusions: Prior nicotine use, alcohol use, and their combination were associated with significant differences in baseline characteristics. However, adjusting for unevenly balanced baseline parameters revealed no differences in functional long-term outcome after ICH.
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Influence of residual fat signal on diffusion kurtosis MRI of suspicious mammography findings - Mlynarska-Bujny, Anna; Bickelhaupt, Sebastian; Laun, Frederik Bernd; König, Franziska; Lederer, Wolfgang; Daniel, Heidi; Ladd, Mark Edward; Schlemmer, Heinz Peter; Delorme, Stefan; Kuder, Tristan Anselm (Scientific Reports, 2020)
Recent studies showed the potential of diffusion kurtosis imaging (DKI) as a tool for improved classification of suspicious breast lesions. However, in diffusion-weighted imaging of the female breast, sufficient fat suppression is one of the main factors determining the success. In this study, the data of 198 patients examined in two study centres was analysed using standard diffusion and kurtosis evaluation methods and three DKI fitting approaches accounting phenomenologically for fat-related signal contamination of the lesions. Receiver operating characteristic curve analysis showed the highest area under the curve (AUC) for the method including fat correction terms (AUC = 0.85, p < 0.015) in comparison to the values obtained with the standard diffusion (AUC = 0.77) and kurtosis approach (AUC = 0.79). Comparing the two study centres, the AUC value improved from 0.77 to 0.86 (p = 0.036) using a fat correction term for the first centre, while no significant difference with no adverse effects was observed for the second centre (AUC 0.89 vs. 0.90, p = 0.95). Contamination of the signal in breast lesions with unsuppressed fat causing a reduction of diagnostic performance of diffusion kurtosis imaging may potentially be counteracted by proposed adapted evaluation methods.
CRIS-Team Scopus Importer:2020-08-14

Influence of risk-organ-based tube current modulation on CT-induced DNA double-strand breaks in a biological phantom model - Brand, Michael; Wüst, Wolfgang; May, Matthias; Uder, Michael; Sommer, Matthias (Journal of Radiation Research, 2018)
Techniques for dose reduction in computed tomography (CT) are receiving increasing attention. Lowering the tube current in front of the patient, known as risk-organ-based tube current modulation (RTM), represents a new approach. Physical dose parameters can determine the exposure but are not able to assess the biological-X-ray interactions. The purpose of this study was to establish a biological phantom model to evaluate the effect of RTM on X-ray-induced DNA double-strand breaks (DSBs). In breast phantoms and in the location of the spine in an Alderson phantom, isolated human blood lymphocytes were irradiated using a 128-slice CT scanner. A standard thoracic CT protocol (120 kV, 110 ref. mAs, anatomy-based tube current modulation, pitch 0.6, scan length 30 cm) with and without RTM was used. X-ray-induced DSBs were quantified in isolated blood lymphocytes using immunofluorescence microscopy after staining for the phosphorylated histone variant γ-H2AX. Using RTM, the resulting DNA damage reduction was 41% in superficial breast locations (P = 0.0001), 28% in middle breast locations (P = 0.0003) and 29% in lower breast locations (P = 0.0001), but we found a DNA damage increase of 36% in superficial spine locations (P = 0.0001) and of 26% in deep spine locations (P = 0.0001). In summary, we established a biological phantom model that is suitable for detecting DNA damage in distinct organs. In addition, we were able to show that, using RTM, X-ray-induced DNA damage in the breast can be significantly reduced; however, there is a significant increase in DSBs in the location of the spine.
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Influence of saturation effects on biexponential liver intravoxel incoherent motion - Loh, Martin; Führes, Tobit; Stuprich, Christoph; Uder, Michael; Saake, Marc; Laun, Frederik Bernd (Magnetic Resonance in Medicine, 2023)
Purpose: Studies on intravoxel incoherent motion (IVIM) imaging in the liver have been carried out with different acquisition protocols. The number of acquired slices and the distances between slices can influence IVIM measurements due to saturation effects, but these effects have often been disregarded. This study investigated differences in biexponential IVIM parameters between two slice settings. Methods: Fifteen healthy volunteers (21–30 years) were examined at a field strength of 3 T. Diffusion-weighted images of the abdomen were acquired with 16 b values (0–800 s/mm2), with four slices for the few slices setting and 24–27 slices for the many slices setting. Regions of interest were manually drawn in the liver. The data were fitted with a monoexponential signal curve and a biexponential IVIM curve, and biexponential IVIM parameters were determined. The dependence on the slice setting was assessed with Student's t test for paired samples (normally distributed IVIM parameters) and the Wilcoxon signed-rank test (non-normally distributed parameters). Results: None of the parameters were significantly different between the settings. For few slices and many slices, respectively, the mean values (SDs) for (Formula presented.) were (Formula presented.) ((Formula presented.)) and (Formula presented.) ((Formula presented.)); for (Formula presented.) they were 29.7% (6.2%) and 27.7% (3.6%); and for (Formula presented.) they were (Formula presented.) ((Formula presented.)) and (Formula presented.) ((Formula presented.)). Conclusion: Biexponential IVIM parameters in the liver are comparable among IVIM studies that use different slice settings, with mostly negligible saturation effects. However, this may not hold for studies that use much shorter TR.
CRIS-Team Scopus Importer:2023-03-24
Keywords: diffusion; IVIM; liver; perfusion; saturation effects

Influence of the Extent of Intraventricular Hemorrhage on Functional Outcome and Mortality in Intracerebral Hemorrhage - Röder, Sebastian; Sprügel, Maximilian; Sembill, Jochen; Giede-Jeppe, Antje; Macha, Kosmas; Madžar, Dominik; Lücking, Hannes; Gerner, Stefan; Kuramatsu, Joji; Huttner, Hagen; Hölter, Philip (Cerebrovascular Diseases, 2019)
Background and Objective: Intraventricular hemorrhage (IVH) is a verified independent prognostic parameter in patients with intracerebral hemorrhage (ICH). However, the impact of the extent of IVH on clinical outcomes is unestablished. Methods: We analyzed 1,112 consecutive primary ICH patients of the UKER-ICH cohort (NCT03183167) and hypothesized that there is no difference in outcome between patients without IVH and patients with minor IVH not leading to obstructive hydrocephalus. Propensity score matching and multivariable analyses were performed to account for imbalances in baseline characteristics. Primary outcome was defined as functional outcome 3 months after ICH -assessed using the modified Rankin Scale (mRS) dichotomized into favorable (mRS = 0-3) and unfavorable outcome (mRS = 4-6). Secondary outcomes included mortality at 3 months and a Graeb score-based threshold analysis for association of the extent of IVH with unfavorable clinical outcome. Results: Among the 461 out of 1,112 (41.5%) ICH patients with IVH, 191 out of 461 (41.4%) showed IVH without obstructive hydrocephalus and no requirement of external ventricular drain (EVD) placement. After adjusting for baseline imbalances we found no difference in functional outcome at 3 months between patients without IVH (No-IVH) and patients with IVH not requiring EVD (IVH-w/o-EVD): mRS 0-3: No-IVH 64/161 (39.8%) vs. IVH-w/o-EVD 53/170 (31.2%); p = 0.103. However, there was a trend toward a higher mortality in IVH-w/o-EVD patients (mRS 6: No IVH 40/161 [24.8%] vs. IVH-w/o-EVD 57/170 [33.5%]; p = 0.083). Multivariable analysis revealed that a Graeb score >2 was independently associated with unfavorable outcome (mRS 4-6: OR 3.16 [1.54-6.48]; p = 0.002), and higher mortality (mRS 6: OR 2.57 [1.40-4.74]; p = 0.002) in IVH patients. Conclusions: Small amounts of intraventricular blood (Graeb score ≤2) not leading to obstructive hydrocephalus are not associated with unfavorable outcome or death after ICH. Thus, IVH per se should not be considered a binary variable in outcome prediction for ICH patients.
CRIS-Team Scopus Importer:2019-07-02

Influence on Outcome and Treatment of Intracerebral Hematoma in Patients with Atraumatic Subarachnoid Hemorrhage - Gerner, Stefan; Kuramatsu, Joji; Reichl, Jonathan; Eyüpoglu, Ilker Yasin; Dörfler, Arnd; Engelhorn, Tobias; Schwab, Stefan; Huttner, Hagen (CEREBROVASCULAR DISEASES, 2019)
CRIS-Team WoS Importer:2020-02-21

Infographic. Can standardised clinical examination of athletes with acute groin injuries predict the presence and location of MRI findings? - Serner, Andreas; Pope, David; Weir, Adam; Tol, Johannes L.; Thorborg, Kristian; Roemer, Frank; Guermazi, Ali; Holmich, Per (British Journal of Sports Medicine, 2018)
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Inhibited Arginase-1 Expression by Fra-1 in Myeloid Cells Enhance Rheumatoid Arthritis Inflammation - Hannemann, Nicole; Schnelzer, A.; Jordan, J.; Eberhardt, Martin; Schleicher, Ulrike; Uebe, Steffen; Ekici, Arif Bülent; Reid, Stephen; Sonnewald, Sophia; Bäuerle, Tobias; Bogdan, Christian; Vera, Julio; et al. (2017)
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INHIBITION OF ARGINASE-1 EXPRESSION BY THE TRANSCRIPTION FACTOR FRA-1 IN MACROPHAGES EXACERBATES RHEUMATOID ARTHRITIS INFLAMMATION - Hannemann, Nicole; Cao, Shan; Schnelzer, A.; Jordan, J.; Eberhardt, Martin; Schleicher, Ulrike; Uebe, Steffen; Ekici, Arif Bülent; Rech, Jürgen; Bäuerle, Tobias; Bogdan, Christian; Vera, Julio; et al. (ANNALS OF THE RHEUMATIC DISEASES, 2019)
CRIS-Team WoS Importer:2019-05-17

Initial clinical results with a fusion prototype for mammography and three-dimensional ultrasound with a standard mammography system and a standard ultrasound probe - Emons, Julius; Wunderle, Marius; Hartmann, Arndt; Radicke, Marcus; Rauh, Claudia; Uder, Michael; Gaß, Paul; Fasching, Peter; Langemann, Hanna; Beckmann, Matthias; Schulz-Wendtland, Rüdiger; Jud, Sebastian (Acta Radiologica, 2018)
BACKGROUND: Combinations *Equal contributors. of different imaging techniques in fusion devices appear to be associated with improvements in diagnostic assessment. PURPOSE: The aim of this study was to test the feasibility of using an automated standard three-dimensional (3D) ultrasound (US) device fused with standard mammography for the first time in breast cancer patients. MATERIAL AND METHODS: Digital mammograms and 3D automated US images were obtained in 23 patients with highly suspicious breast lesions. A recently developed fusion machine consisting of an ABVS 3D US transducer from an Acuson S2000 machine and a conventional Mammomat Inspiration device (both Siemens Healthcare GmbH, Erlangen, Germany) were used for the purpose. The feasibility of the examinations, imaging coverage, and patients' experience of the procedure were examined. RESULTS: In 15 out of 19 patients, the region of interest (ROI) with the tumor marked in the mammogram was visible on US. The examination was experienced positively by the patients, with no unexpected pain or injury. The examination was time-saving and well tolerated. CONCLUSION: In conclusion, we have shown initial clinical feasibility of an US/radiography fusion prototype with good localization and evaluation of the ROIs. The combined examination was well tolerated. The simultaneous evaluation with mammography and US imaging may be able to improve detection and reduce examiner-related variability.
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Initial experience with a next-generation low-field MRI scanner: Potential for breast imaging? - Dietzel, Matthias; Laun, Frederik Bernd; Heiß, Rafael; Wenkel, Evelyn; Bickelhaupt, Sebastian; Hack, Carolin; Uder, Michael; Ohlmeyer, Sabine (European Journal of Radiology, 2024)
Purpose: Broader clinical adoption of breast magnetic resonance imaging (MRI) faces challenges such as limited availability and high procedural costs. Low-field technology has shown promise in addressing these challenges. We report our initial experience using a next-generation scanner for low-field breast MRI at 0.55T. Methods: This initial cases series was part of an institutional review board-approved prospective study using a 0.55T scanner (MAGNETOM Free.Max, Siemens Healthcare, Erlangen/Germany: height < 2 m, weight < 3.2 tons, no quench pipe) equipped with a seven-channel breast coil (Noras, Höchberg/Germany). A multiparametric breast MRI protocol consisting of dynamic T1-weighted, T2-weighted, and diffusion-weighted sequences was optimized for 0.55T. Two radiologists with 12 and 20 years of experience in breast MRI evaluated the examinations. Results: Twelve participants (mean age: 55.3 years, range: 36–78 years) were examined. The image quality was diagnostic in all examinations and not impaired by relevant artifacts. Typical imaging phenotypes were visualized. The scan time for a complete, non-abbreviated breast MRI protocol ranged from 10:30 to 18:40 min. Conclusion: This initial case series suggests that low-field breast MRI is feasible at diagnostic image quality within an acceptable examination time.
CRIS-Team Scopus Importer:2024-02-23
Keywords: 0.55T; Accessibility; Breast cancer; Breast MRI; Breast neoplasms; Diagnostic techniques and procedures; Diffusion magnetic resonance imaging; Efficiency; Low-field; Low-field system; Magnetic resonance imaging; Point-of-care; Socioeconomic

Initiating anticoagulant therapy after ICH is associated with patient characteristics and treatment recommendations - Sembill, Jochen; Wieser, Claudia; Sprügel, Maximilian; Gerner, Stefan; Giede-Jeppe, Antje; Reindl, Caroline; Eyüpoglu, Ilker Yasin; Lücking, Hannes; Kuramatsu, Joji; Huttner, Hagen; Hölter, Philip (Journal of Neurology, 2018)
The proportion of patients with intracerebral hemorrhage (ICH) and concomitant indication for oral anticoagulant (OAC) therapy is increasing. Although recent studies documented a favorable risk-benefit profile of OAC initiation, deciding whether, when, and which OAC should be started remains controversial. We investigated (1) OAC recommendations, its implementation, and adherence and (2) factors associated with OAC initiation after ICH. This prospective observational study analyzed consecutive ICH patients (n = 246) treated at the neurological and neurosurgical department of the University-Hospital Erlangen, Germany over a 21-month inclusion period (05/2013-01/2015). We analyzed the influence of patient characteristics, in-hospital measures, and functional status on treatment recommendations and on OAC initiation during 12-month follow-up. In-hospital mortality of 24.8% (n = 61/246) left 185 patients discharged alive of which 34.1% (n = 63/185) had OAC indication. In these patients, OAC initiation was clearly recommended in only 49.2% (n = 31/63) and associated with favorable [modified Rankin Scale (mRS) = 0-3] functional discharge status [OR 7.18, CI (1.05-49.13), p = 0.04], less frequent heart failure [OR 0.19, CI (0.05-0.71), p = 0.01], and younger age [OR 0.95, CI (0.90-1.00), p = 0.05]. OAC was more often started if clearly recommended [n = 19/31 (61.3%) versus (no recommendation) n = 4/26 (15.4%), p < 0.001; (clearly not recommended, n = 6)] and associated with younger age [67 (58-74) versus 79 (73-83), p < 0.001], favorable functional outcome [n = 10/23 (43.5%) versus n = 5/40 (12.5%), p = 0.01], decreased mortality [n = 6/23 (26.1%) versus n = 19/40 (47.5%), p = 0.06], and functional improvement [n = 13/17 (76.5%) versus n = 7/21 (33.3%), p = 0.01]. We observed no differences in rates of intracranial complications [thromboembolism, n = 3/23 (13.0%) versus n = 4/40 (10.0%), p = 1.00; hemorrhage, n = 1/23 (4.3%) versus n = 3/40 (7.5%), p = 1.00]. Clear treatment recommendations by attending stroke physicians significantly influence OAC initiation after ICH. OAC were more frequently recommended and started in younger patients with better functional recovery independent from intracranial complications. This might represent an important determinant of observed beneficial associations, hinting towards an indication bias which might affect observational analyses.
EVALuna2:34916

Injuries of the scapholunate and lunotriquetral ligaments as well as the TFCC in intra-articular distal radius fractures. Prevalence assessed with MDCT arthrography - Klempka, A.; Wagner, M.; Fodor, S.; Prommersberger, K. J.; Uder, Michael; Schmitt, R. (European Radiology, 2016)
To evaluate the prevalence of injuries of the scapholunate and lunotriquetral interosseous ligaments (SLIL, LTIL) as well as the triangular fibrocartilage complex (TFCC) in intra-articular distal radius fractures (iaDRF).Two hundred and thirty-three patients with acute iaDRF underwent MDCT arthrography. The SLIL and LTIL were described as normal, partially or completely ruptured. Major injuries of the SLIL were defined as completely ruptured dorsal segments, those of the LTIL as completely ruptured palmar segments. The TFCC was judged as normal or injured. Interobserver variability was calculated. Injury findings were correlated with the types of iaDRF (AO classification).In 159 patients (68.2 %), no SLIL injuries were seen. Minor SLIL injuries were detected in 54 patients (23.2 %), major injuries in 20 patients (8.6 %). No correlation was found between the presence of SLIL lesions and the types of iaDRF. Minor LTIL injuries were seen in 23 patients (9.9 %), major injuries in only 5 patients (2.2 %). The TFCC was altered in 141 patients (60.5 %). Interobserver variability was high for MDCT arthrography in assessing SLIL and TFC lesions, and fair for LTIL lesions.In iaDRF, prevalence of major injuries of the most relevant SLIL is about 9 % as evaluated with CT arthrography.o The C-shaped SLIL is built of dorsal, middle and palmar segments. o In iaDRF, major SLIL injuries are associated in 8.6 % of the cases. o In iaDRF, the SLIL remains intact in 68.3 % of the cases. o IaDRF and SLIL ruptures can comprehensively be depicted with MDCT arthrography. o A three-compartment approach is recommended to assess intrinsic ligaments and the TFCC.
EVALuna2:14470

Insular Cortical Thickness in Patients With Somatoform Pain Disorder: Are There Associations With Symptom Severity and Childhood Trauma? - Meyer, Elisabeth; Morawa, Eva; Nacak, Yeliz; Rösch, Julie; Dörfler, Arnd; Forster, Clemens; Erim, Yesim (Frontiers in Psychiatry, 2020)
Background: Studies show significant alterations in insular cortical thickness in patients with somatoform pain disorder (SPD). Additionally, associations between childhood maltreatment and morphometric alterations in insular cortex have been observed. Since patients with SPD often report about adverse childhood experiences, we were interested in the interrelationship of exposure to childhood maltreatment and insular cortical thickness in patients with SPD. Methods: Fifteen adult patients with SPD (ICD-10 F 45.40/41, DSM-Code 307.80) and thirteen healthy adult controls underwent T1-weighted MR brain imaging. In the voxel-based morphometry (VBM) analysis we compared whole brain cortical thickness between patients and controls using a Student’s two-sampled t-test (p <.05). Then we performed a secondary analysis to detect differences in cortical thickness levels in the insular cortex between both groups. For further analysis of differences in insular cortical thickness we used gender, age, depressive symptoms [Patient Health Questionnaire (PHQ)-9], and whole brain cortical thickness as nuisance covariates. Subsequently we explored associations between insular cortical thickness, symptom severity (PHQ-15) and past experiences of childhood maltreatment (CTQ) in both groups. Results: Patients showed reduced insular cortical thickness in a subregion of right Brodmann area (BA) 13 (anterior part of the insular cortex), whereas whole brain cortical thickness did not differ between groups. The between-group difference in the identified insular subregion of right BA 13 was not diminished by any of the covariates. This implies that the reduction in cortical thickness in the identified insular subregion might be due to a specific group effect. The effect sizes indicate that the group of patients experienced more childhood maltreatment than the control group. Nonetheless, significant correlations of insular cortical thickness with symptom severity and childhood maltreatment in the total collective could not be demonstrated for the group of patients. Conclusions: Our data suggest that alterations in the identified insular subregion of right BA 13 are associated with somatoform pain, independent of gender, age, or coincident depression levels. To identify significant associations of insular cortical thickness and experiences of childhood maltreatment in patients with SPD investigations within larger samples are highly recommended.
CRIS-Team Scopus Importer:2020-10-02
Keywords: childhood maltreatment; cortical thickness; insula; somatoform pain; voxel-based morphometry

Insular multiple sclerosis lesions are associated with erectile dysfunction - Winder, Klemens; Linker, Ralf; Seifert, Frank; Deutsch, Martina; Engelhorn, Tobias; Dörfler, Arnd; Lee, De-Hyung; Hoesl, Katharina M.; Hilz, Max-Josef (Journal of Neurology, 2018)
Erectile function (EF) is frequently compromised in men with multiple sclerosis (MS). Functional neuroimaging in healthy men identified a network of brain areas, such as the insula, visual and somatosensory association areas, cingulate gyrus, prefrontal cortex, as well as subcortical regions, contributing to EF. This study intended to determine associations between EF deterioration during MS and cerebral MS-associated lesion sites. In 31 men with MS (mean age 38.2 ± 11.2 years), we evaluated MS-related EF deterioration by comparing scores of the 5-item International Index of Erectile Function-5 questionnaire (IIEF5) at the time of study and retrospectively, 3 months prior to MS diagnosis, by calculating score differences as DeltaIIEF5 (DeltaIIEF5 score < 0 indicated EF deterioration). To assess the impact of confounding factors of EF, patient age, disease duration, disease severity, depressiveness, bladder and bowel symptoms, and total cerebral MS lesion volume were correlated with DeltaIIEF5 scores (Spearman rank correlation) and compared between patients with and without EF deterioration (t tests or Mann-Whitney U test). MS lesions were assessed on T2-weighted magnetic resonance imaging (MRI; 1.5 or 3 T). We determined the lesion overlap (prevalence of identical lesion sites among patients), subtracted lesion overlaps in patients without EF deterioration from overlaps in patients with EF deterioration, and compared DeltaIIEF5 scores voxel-wise between patients with and without lesions in a given voxel (t test; significance: p < 0.05). In 14 patients (45.2%), DeltaIIEF5 scores indicated EF deterioration. DeltaIIEF5 scores were not associated with age (ρ = 0.06; p = 0.74), disease duration (ρ = 0.26; p = 0.15), disease severity (ρ = - 0.19; p = 0.31), depressiveness (ρ = 0.07; p = 0.72), bladder symptoms (ρ = - 0.11; p = 0.57), bowel symptoms (ρ = 0.17; p = 0.37), and total lesion volume (ρ = - 0.13; p = 0.47). The voxel-wise analysis showed associations between EF deterioration and MS lesions primarily in the bilateral, and predominantly left juxtacortical insular region. In conclusion, MS lesions particularly in the left insular region, which is activated with sexual arousal, contribute to erectile dysfunction.
EVALuna2:34021

Integrity/Demyelination of the optic radiation, morphology of the papilla, and contrast sensitivity in glaucoma patients - Michelson, Georg; Wärntges, Simone; Engelhorn, Tobias; El-Rafei, Ahmed Mohamed Ibrahim; Hornegger, Joachim; Dörfler, Arnd (Klinische Monatsblätter für Augenheilkunde, 2012)
Background: In primary open angle glaucoma (POAG) and its non-barotraumatic subgroup, normal tension glaucoma (NTG), the pathophysiological differences are not clear. A participation of the 4th neuron of the visual pathway (optic radiation) appears possible on the basis of related experimental studies. The goal of the present study was the evaluation of the optic radiation by diffusion tensor imaging (DTI), which is based on the magnetic resonance imaging. The diffusion and anisotropy parameters of the optic radiation as a marker of axonal integrity and demyelination/damage of glial cells, respectively, were used to investigate the relation between the morphology of the papilla (BLDF, linear discriminant function of Burk) and the contrast sensitivity (FDT, frequency doubling test). Patients and Methods: In this prospective observational study 13 POAG patients, 13 NTG patients, and 7 control patients of the same mean age were included. For segmentation of the optic radiation a semi-automated algorithm was applied and the diffusion and anisotropy parameters were calculated. The importance of the covariates age, BLDF, and FDT for the DTI parameters was determined using partial correlation analysis. Results: Analysis of the covariates partially showed a clear autocorrelation. The correlations between the DTI parameters and BLDF were significant in all groups after correction of the measurement values for the covariates. FDT correlated with DTI parameters in controls and POAG. The NTG group did not show this correlation due to a strong spreading of the FDT values. Conclusion: After statistical elimination of the autocorrelation of the covariates age, BLDF, and FDT the morphology of the papilla correlated with the axonal integrity and demyelination/glia cell impairment of the optic radiation in controls and glaucoma. In NTG the impaired contrast sensitivity is highly variable and is not associated with the condition of the 3rd or 4th neuron, respectively, as compared to POAG. The autocorrelation between individual covariates represents an important element for the judgement of the visual pathway. © Georg Thieme Verlag KG · Stuttgart · New York.

Inter- and intra-observer variability of an anatomical landmark-based, manual segmentation method by MRI for the assessment of skeletal muscle fat content and area in subjects from the general population - Kiefer, Lena Sophie; Fabian, Jana; Lorbeer, Roberto; Machann, Juergen; Storz, Corinna; Kraus, Mareen Sarah; Wintermeyer, Elke; Schlett, Christopher; Roemer, Frank; Nikolaou, Konstantin; Peters, Annette; Bamberg, Fabian (British Journal of Radiology, 2018)
OBJECTIVES: Changes in skeletal muscle composition, such as fat content and mass, may exert unique metabolic and musculoskeletal risks; however, the reproducibility of their assessment is unknown. We determined the variability of the assessment of skeletal muscle fat content and area by MRI in a population-based sample. METHODS: A random sample from a prospective, community-based cohort study (KORA-FF4) was included. Skeletal muscle fat content was quantified as proton-density fat fraction (PDFF) and area as cross-sectional area (CSA) in multi-echo Dixon sequences (TR 8.90 ms, six echo times, flip angle 4°) by a standardized, anatomical landmark-based, manual skeletal muscle segmentation at level L3 vertebra by two independent observers. Reproducibility was assessed by intraclass correlation coefficients (ICC), scatter and Bland-Altman plots. RESULTS: From 50 subjects included (mean age 56.1 ± 8.8 years, 60.0% males, mean body mass index 28.3 ± 5.2) 2'400 measurements were obtained. Interobserver agreement was excellent for all muscle compartments (PDFF: ICC0.99, CSA: ICC0.98) with only minor absolute and relative differences (-0.2 ± 0.5%, 31 ± 44.7 mm2; -2.6 ± 6.4% and 2.7 ± 3.9%, respectively). Intra-observer reproducibility was similarly excellent (PDFF: ICC1.0, 0.0 ± 0.4%, 0.4%; CSA: ICC1.0, 5.5 ± 25.3 mm2, 0.5%, absolute and relative differences, respectively). All agreement was independent of age, gender, body mass index, body height and visceral adipose tissue (ICC0.96-1.0). Furthermore, PDFF reproducibility was independent of CSA (ICC0.93-0.99). Conclusions: Quantification of skeletal muscle fat content and area by MRI using an anatomical landmark-based, manual skeletal muscle segmentation is highly reproducible. Advances in knowledge: An anatomical landmark-based, manual skeletal muscle segmentation provides high reproducibility of skeletal muscle fat content and area and may therefore serve as a robust proxy for myosteatosis and sarcopenia in large cohort studies.
EVALuna2:35368

Interdisziplinäre neurovaskuläre Netzwerke: eine Standortbestimmung - Röther, J.; Busse, O.; Berlis, A.; Dörfler, Arnd; Groden, Ch; Hamann, G.; Jansen, O.; Meixensberger, J.; Müller, O.; Regelsberger, J.; Steinmetz, H.; Vatter, H.; et al. (Der Nervenarzt, 2020)
Background: In order to treat the complete spectrum of neurovascular diseases at a high level of quality, which goes beyond the purely acute treatment of stroke, the German Stroke Society (DSG) together with the German Societies for Neurosurgery and Neuroradiology developed a certification procedure for neurovascular networks (NVN). Structurally, a NVN consists of a coordinating center with at least three neurovascular network partners with a certified stroke unit. From 2018 to 2020 a total of 15 NVN have so far been audited and certified according to this new standard. Objective: How efficient are the NVN? Are high standards maintained? Material and methods: The reports of the audits were analyzed. The data were taken from the period 2017–2019. Results: The 15 NVN treated a total of 86,510 stroke patients in the years examined and were networked with a total of 107 partner clinics, which were situated an average of 25 km from the coordinating center and transferred a total of 2726 patients. The coordinating centers performed 2463 thrombectomies and treated 2383 patients with nontraumatic intracerebral bleeding. In 712 patients with acute aneurysmatic subarachnoid hemorrhages endovascular treatment was carried out and clipping in 401. The audit was successful in the majority of the NVN. Conclusion: The certification process of NVN has been successfully established and the audits proved to be a useful instrument for quality control and improvement. The 15 NVN are highly efficient and treat more than one quarter of stroke patients in German stroke units.
CRIS-Team Scopus Importer:2020-09-25
Keywords: Clipping; Endovascular treatment; Interhospital cooperation; Stroke unit; Thrombectomy

Interictal Electrical Source Imaging. - Rampp, Stefan; Müller-Voggel, Nadia; Hamer, Hajo; Dörfler, Arnd; Brandner, Sebastian; Buchfelder, Michael (Journal of Clinical Neurophysiology, 2024)
Interictal electrical source imaging (ESI) determines the neuronal generators of epileptic activity in EEG occurring outside of seizures. It uses computational models to take anatomic and neuronal characteristics of the individual patient into account. The presented article provides an overview of application and clinical value of interictal ESI in patients with pharmacoresistant focal epilepsies undergoing evaluation for surgery. Neurophysiological constraints of interictal data are discussed and technical considerations are summarized. Typical indications are covered as well as issues of integration into clinical routine. Finally, an outlook on novel markers of epilepsy for interictal source analysis is presented. Interictal ESI provides diagnostic performance on par with other established methods, such as MRI, PET, or SPECT. Although its accuracy benefits from high-density recordings, it provides valuable information already when applied to EEG with only a limited number of electrodes with complete coverage. Novel oscillatory markers and the integration of frequency coupling and connectivity may further improve accuracy and efficiency.
EVALuna2:547206

Interictal magnetoencephalography used in magnetic resonance imaging-negative patients with epilepsy - Wu, Xueqing; Rampp, Stefan; Buchfelder, Michael; Kuwert, Torsten; Blümcke, Ingmar; Zhou, D.; Stefan, Herrmann; Dörfler, Arnd (Acta Neurologica Scandinavica, 2013)
Purpose: This study aims to investigate the contributions of magnetoencephalography (MEG) in magnetic resonance imaging (MRI)-negative patients. Methods: A total of 18 MRI-negative patients diagnosed with refractory epilepsy, subjected to MEG investigation, and subsequently underwent surgery were selected for retrospective analysis. A 1.5-tesla Magnetom Sonata with an eight-channel head array coil was used. MEG data were obtained using a 74/248-channel system. Results: A total of 16 patients (16/18) had positive MEG results, comprising 12 patients with monofocal localizations, five with multifocal localizations, and one with unremarkable results in MEG. In addition, 12 patients had indicative single photon-emission computed tomography (SPECT), five had indicative fluorodeoxyglucose positron emission tomography (FDG-PET), and all the patients had intracranial electroencephalography (EEG) (14 with subdural electrodes and four with electrocorticography). The intracranial EEG recordings of nine patients were guided by MEG informative results. Among these 18 patients, 10 exhibited good postoperative outcomes (Engel I and II), four of which were completely seizure-free. All these ten patients had clear monofocal localization in MEG, including nine with accordant indicative metabolic changes in either SPECT or FDG-PET, or both. None of the five patients with multifocal localizations achieved good postoperative outcomes. Conclusion: For cases with negative MRI findings, epilepsy surgery may be an alternative option for pharmaco-resistant patients if epileptogenic focus localizations by MEG are present in multimodal evaluation. © 2012 John Wiley & Sons A/S.
CRIS-Team Scopus Importer:2022-08-05
Keywords: Magnetic resonance imaging; Magnetoencephalography; Non-lesional epilepsy; Outcome

Interobserver and intermodality agreement of standardized algorithms for non-invasive diagnosis of hepatocellular carcinoma in high-risk patients: CEUS-LI-RADS versus MRI-LI-RADS - Schellhaas, Barbara; Hammon, Matthias; Strobel, Deike; Pfeifer, Lukas; Kielisch, Christian; Görtz, Rüdiger; Janka, Rolf Matthias; Neurath, Markus; Uder, Michael; Seuß, Hannes; Cavallaro, Alexander Josef (European Radiology, 2018)
OBJECTIVES: We compared the interobserver agreement for the recently introduced contrast-enhanced ultrasound (CEUS)-based algorithm CEUS-LI-RADS (Liver Imaging Reporting and Data System) versus the well-established magnetic resonance imaging (MRI)-LI-RADS for non-invasive diagnosis of hepatocellular carcinoma (HCC) in high-risk patients. METHODS: Focal liver lesions in 50 high-risk patients (mean age 66.2 ± 11.8 years; 39 male) were assessed retrospectively with CEUS and MRI. Two independent observers reviewed CEUS and MRI examinations, separately, classifying observations according to CEUS-LI-RADSv.2016 and MRI-LI-RADSv.2014. Interobserver agreement was assessed with Cohen's kappa. RESULTS: Forty-three lesions were HCCs; two were intrahepatic cholangiocarcinomas; five were benign lesions. Arterial phase hyperenhancement was perceived less frequently with CEUS than with MRI (37/50 / 38/50 lesions = 74%/78% [CEUS; observer 1/observer 2] versus 46/50 / 44/50 lesions = 92%/88% [MRI; observer 1/observer 2]). Washout appearance was observed in 34/50 / 20/50 lesions = 68%/40% with CEUS and 31/50 / 31/50 lesions = 62%/62%) with MRI. Interobserver agreement was moderate for arterial hyperenhancement (ĸ = 0.511/0.565 [CEUS/MRI]) and "washout" (ĸ = 0.490/0.582 [CEUS/MRI]), fair for CEUS-LI-RADS category (ĸ = 0.309) and substantial for MRI-LI-RADS category (ĸ = 0.609). Intermodality agreement was fair for arterial hyperenhancement (ĸ = 0.329), slight to fair for "washout" (ĸ = 0.202) and LI-RADS category (ĸ = 0.218) CONCLUSION: Interobserver agreement is substantial for MRI-LI-RADS and only fair for CEUS-LI-RADS. This is mostly because interobserver agreement in the perception of washout appearance is better in MRI than in CEUS. Further refinement of the LI-RADS algorithms and increasing education and practice may be necessary to improve the concordance between CEUS and MRI for the final LI-RADS categorization. KEY POINTS: • CEUS-LI-RADS and MRI-LIRADS enable standardized non-invasive diagnosis of HCC in high-risk patients. • With CEUS, interobserver agreement is better for arterial hyperenhancement than for "washout". • Interobserver agreement for major features is moderate for both CEUS and MRI. • Interobserver agreement for LI-RADS category is substantial for MRI, and fair for CEUS. • Interobserver-agreement for CEUS-LI-RADS will presumably improve with ongoing use of the algorithm.
EVALuna2:34689

INTERSITE COMPARISON AND TEST-RETEST RELIABILITY OF CARTILAGE THICKNESS AND COMPOSTIONAL ANALYSIS IN THE APPROACH STUDY - A 2-YEAR MULTICENTER EUROPEAN EXPLORATORY STUDY FOR PHENOTYPE CHARACTERIZATON OF KNEE OSTEOARTHRITIS - Eckstein, F.; Maschek, S.; Bay-Jensen, A.; Boere, J.; Hussaarts, L.; Ladel, C.; Lalande, A.; Larkin, J.; Loughlin, J.; Mobasheri, A.; Palozzi, L.; Weinans, H.; et al. (OSTEOARTHRITIS AND CARTILAGE, 2019)
CRIS-Team WoS Importer:2019-05-21

Intra-abdominal ALK-positive anaplastic large cell lymphoma in a patient with neurofibromatosis type 1 - Agaimy, Abbas; Semrau, Sabine; Heinz, Marco (Histopathology, 2016)
EVALuna2:6768

Intra- and interrater reliability of three different MRI grading and classification systems after acute hamstring injuries - Wangensteen, Arnlaug; Tol, Johannes L.; Roemer, Frank; Bahr, Roald; Dijkstra, H. Paul; Crema, Michel D.; Farooq, Abdulaziz; Guermazi, Ali (European Journal of Radiology, 2017)
To assess and compare the intra- and interrater reliability of three different MRI grading and classification systems after acute hamstring injury.Male athletes (n=40) with clinical diagnosis of acute hamstring injury and MRI <=5days were selected from a prospective cohort. Two radiologists independently evaluated the MRIs using standardised scoring form including the modified Peetrons grading system, the Chan acute muscle strain injury classification and the British Athletics Muscle Injury Classification. Intra-and interrater reliability was assessed with linear weighted kappa (?) or unweighted Cohen's ? and percentage agreement was calculated.We observed 'substantial' to 'almost perfect' intra- (? range 0.65-1.00) and interrater reliability (? range 0.77-1.00) with percentage agreement 83-100% and 88-100%, respectively, for severity gradings, overall anatomical sites and overall classifications for the three MRI systems. We observed substantial variability (? range -0.05 to 1.00) for subcategories within the Chan classification and the British Athletics Muscle Injury Classification, however, the prevalence of positive scorings was low for some subcategories.The modified Peetrons grading system, overall Chan classification and overall British Athletics Muscle Injury Classification demonstrated 'substantial' to 'almost perfect' intra- and interrater reliability when scored by experienced radiologists. The intra- and interrater reliability for the anatomical subcategories within the classifications remains unclear.
EVALuna2:14670

Intra-articular Coricosteroid Injections in the Nip and Knee: Perhaps Not as Safe as We Thought? - Kompel, Andrew J.; Roemer, Frank; Murakami, Akira M.; Diaz, Luis E.; Crema, Michel D.; Guermazi, Ali (Radiology, 2019)
Osteoarthritis (OA) of the hip and knee is among the most common joint disorders. Infra-articular corticosteroid (MC'S) injections are frequently performed to treat OA and other joint-related pain syndromes; however, there is conflicting evidence on their potential benefit. There is a lack of prospective and large retrospective studies evaluating potential joint findings, including increased risk for accelerated OA progression or adverse joint events, after treetment with IACS injection. Four main adverse joint findings have been structurally observed in patients after IACS injections: accelerated OA progression, subchondral insufficiency fracture, complications of osteonecrosis, and rapid joint destruction, including bone loss. Physicians, including radiologists, should be familiar with imaging findings and patient characteristics that may help them identify potential joints at risk for such events. The purpose of this re-port is to review the existing literature, describe observed adverse joint events after IACS injections, and provide an outlook on how this may affect clinical practice. Additional research endeavors are urgently needed to better understand and identify risk factors prior to intervention and to detect adverse joint events after injection as early as possible to prevent or minimize complications. (C) RSNA. 2019
CRIS-Team WoS Importer:2019-12-06

Intra-articular corticosteroid injections for the treatment of hip and knee osteoarthritis-related pain: Considerations and controversies with a focus on imaging-radiology scientific expert panel - Guermazi, Ali; Neogi, Tuhina; Katz, Jeffrey N.; Kwoh, C. Kent; Conaghan, Philip G.; Felson, David T.; Roemer, Frank (Radiology, 2020)
Current management of osteoarthritis (OA) is primarily focused on symptom control. Intra-articular corticosteroid (IACS) injections are often used for pain management of hip and knee OA in patients who have not responded to oral or topical analgesics. Recent case series suggested that negative structural outcomes including accelerated OA progression, subchondral insufficiency fracture, complications of pre-existing osteonecrosis, and rapid joint destruction (including bone loss) may be observed in patients who received IACS injections. This expert panel report reviews the current understanding of pain in OA, summarizes current international guidelines regarding indications for IACS injection, and considers preinterventional safety measures, including imaging. Potential profiles of those who would likely benefit from IACS injection and a suggestion for an updated patient consent form are presented. As of today, there is no established recommendation or consensus regarding imaging, clinical, or laboratory markers before an IACS injection to screen for OA-related imaging abnormalities. Repeating radiographs before each subsequent IACS injection remains controversial. The true cause and natural history of these complications are unclear and require further study. To determine the cause and natural history, large prospective studies evaluating the risk of accelerated OA or joint destruction after IACS injections are needed. However, given the relatively rare incidence of these adverse outcomes, any clinical trial would be challenging in design and a large number of patients would need to be included.
CRIS-Team Scopus Importer:2020-11-27

Intramuscular Perfusion Response in Delayed Onset Muscle Soreness (DOMS): A Quantitative Analysis with Contrast-Enhanced Ultrasound (CEUS) - Kellermann, Marion; Heiss, Rafael; Swoboda, Bernd; Gelse, Kolja; Freiwald, Jürgen; Grim, Casper; Nagel, Armin Michael; Uder, Michael; Wildner, Dane; Hotfiel, Thilo (International Journal of Sports Medicine, 2017)
The purpose of this study was to analyse intramuscular perfusion response in ultrastructural muscle lesions, by applying contrast-enhanced ultrasound (CEUS) to a delayed onset muscle soreness (DOMS) model. Results of this analysis were compared to high-resolution 3 Tesla MRI T2-weighted sequences. 14 healthy participants were recruited. Average perfusion parameters, represented as Peak enhancement (contrast agent inflow) and wash-in area under curve (WiAUC) of the gastrocnemius (GM) and soleus muscle (SM) were assessed before (baseline) and 60 h after inducing DOMS by eccentric exercise. Additionally, conventional ultrasound, high-resolution 3T MRI, creatine kinase level, range of motion (ROM) of the ankle joint, calf circumference and muscle soreness data were collected. Perfusion quantification revealed a statistically significant increase of intramuscular perfusion, corresponding to an increase in peak enhancement of 129.6% (p=0.0031) and in WiAUC of 115.2% (p=0.0107) in the gastrocnemius muscle at post-intervention. At follow-up, the MRI investigations showed intramuscular oedema for GM in all participants corresponding to a significant rise in T2 signal intensity (p=0.001) and in T2 time value (p=0.005). CEUS seems to be able to detect intramuscular perfusion changes and therefore may contribute to gaining deeper insight into the histopathology, inflammatory reactions and regeneration processes of ultrastructural muscle lesions.
EVALuna2:10913

Intraparenchymal Hyperattenuations on Flat-Panel CT Directly After Mechanical Thrombectomy are Restricted to the Initial Infarct Core on Diffusion-Weighted Imaging. - Schneider, Tanja; Mahraun, Tobias; Schroeder, Julian; Froelich, Andreas; Hölter, Philip; Wagner, Marlies; Darcourt, Jean; Cognard, Christophe; Bonafe, Alain; Fiehler, Jens; Siemonsen, Susanne; Buhk, Jan-Hendrik (Clinical Neuroradiology, 2018)
PURPOSE: The presence of intraparenchymal hyperattenuations (IPH) on flat-panel computed tomography (FP-CT) after endovascular recanalization in stroke patients is a common phenomenon. They are thought to occur in ischemic areas with breakdown of the blood-brain barrier but previous studies that investigated a mutual interaction are scarce. We aimed to assess the relationship of IPH localization with prethrombectomy diffusion-weighted imaging (DWI) lesions. METHODS: This retrospective multicenter study included 27 acute stroke patients who underwent DWI prior to FP-CT following mechanical thrombectomy. After software-based coregistration of DWI and FP-CT, lesion volumetry was conducted and overlapping was analyzed. RESULTS: Two different patterns were observed: IPH corresponding to the DWI lesion and IPH exceeding the DWI lesion. The latter showed demarcated infarction of DWI exceeding IPH at 24 h. No major hemorrhage following IPH was observed. Most IPH were manifested within the basal ganglia and insular cortex. CONCLUSION: The IPH primarily appeared within the initial ischemic core and secondarily within the penumbral tissue that progressed to infarction. The IPH represent the minimum final infarct volume, which may help in periinterventional decision making.
EVALuna2:382841

Intraprocedural angiographic CT as a valuable tool in the course of endovascular treatment of direct sinus cavernous fistulas - Gölitz, Philipp; Struffert, Tobias; Saake, Marc; Knossalla, F.; Dörfler, Arnd (Interventional Neuroradiology, 2012)
This investigation aimed to demonstrate the potential of intraprocedural angiographic CT in monitoring complex endovascular coil embolization of direct carotid cavernous fistulas. Angiographic CT was performed as a dual rotational 5 s run with intraarterial contrast medium injection in two patients during endovascular coil embolization of direct carotid cavernous fistulas. Intraprocedural angiographic CT was considered helpful if conventional 2D series were not conclusive concerning coil position or if a precise delineation of the parent artery was impossible due to a complex anatomy or overlying coil material. During postprocessing multi-planar reformatted and dual volume images of angiographic CT were reconstructed. Angiographic CT turned out to be superior in the intraprocedural visualization of accidental coil migration into the parent artery where conventional 2D-DSA series failed to reliably detect coil protrusion. The delineation of coil protrusion by angiographic CT allowed immediate correct coil repositioning to prevent parent artery compromising. Angiographic CT can function as a valuable intraprocedurally feasible tool during complex coil embolizations of direct carotid cavernous fistulas. It allows the precise visualization of the cerebral vasculature and any accidental coil protrusion can be determined accurately in cases where conventional 2D-DSA series are unclear or compromised. Thus angiographic CT might contribute substantially to reduce procedural complications and to increase safety in the management of endovascular treatment of direct carotid cavernous fistulas.
CRIS-Team Scopus Importer:2022-08-05
Keywords: Carotid cavernous fistula; Endovascular approach; Intraprocedural angiographic CT; Transarterial coil embolization

Intratumoral heterogeneity of oxygen metabolism and neovascularization uncovers 2 survival-relevant subgroups of IDH1 wild-type glioblastoma - Stadlbauer, Andreas; Zimmermann, Max; Dörfler, Arnd; Oberndorfer, Stefan; Buchfelder, Michael; Coras, Roland; Kitzwoegerer, Melitta; Roessler, Karl (Neuro-Oncology, 2018)
Background: The intratumoral heterogeneity of oxygen metabolism in combination with variable patterns of neovascularization (NV) as well as reprogramming of energy metabolism affects the landscape of tumor microenvironments (TMEs) in glioblastoma. Knowledge of the hypoxic and perivascular niches within the TME is essential for understanding treatment failure. Methods: Fifty-two patients with untreated glioblastoma (isocitrate dehydrogenase 1 wild type [IDH1wt]) were examined with a physiological MRI protocol including a multiparametric quantitative blood oxygen level dependent (qBOLD) approach and vascular architecture mapping (VAM). Imaging biomarker information about oxygen metabolism (mitochondrial oxygen tension) and neovascularization (microvascular density and type) were fused for classification of 6 different TMEs: necrosis, hypoxia with/without neovascularization, oxidative phosphorylation (OxPhos), and glycolysis with/without neovascularization. Association of the different TME volume fractions with progression-free survival (PFS) was assessed using Kaplan-Meier analysis and Cox proportional hazards models. Results: A common spatial structure of TMEs was detected: central necrosis surrounded by tumor hypoxia (with defective and functional neovasculature) and different TMEs with a predominance of OxPhos and glycolysis for energy production, respectively. The percentage of the different TMEs on the total tumor volume uncovered 2 clearly different subtypes of glioblastoma IDH1wt: a glycolytic dominated phenotype with predominantly functional neovasculature and a necrotic/hypoxic dominated phenotype with approximately 50% of defective neovasculature. Patients with a necrotic/hypoxic dominated phenotype showed significantly shorter PFS (P = 0.035). Conclusions: Our non-invasive mapping approach allows for classification of the TME and detection of tumor-supportive niches in glioblastoma which may be helpful for both clinical patient management and research.
EVALuna2:36560

Intraventricular fibrinolysis does not increase perihemorrhagic edema after intracerebral hemorrhage - Volbers, Bastian; Wagner, Irina; Willfarth, Wolfgang; Dörfler, Arnd; Schwab, Stefan; Staykov, Dimitre (Stroke, 2013)
BACKGROUND AND PURPOSE - : Additional intraventricular hemorrhage leads to higher mortality and worse functional outcome after intracerebral hemorrhage (ICH). Intraventricular fibrinolysis (IVF) with recombinant tissue plasminogen activator (rtPA) is an emerging treatment strategy for such patients. However, experimental studies suggest that rtPA may exert proedematous effects and lead to increased perihemorrhagic edema (PHE) after ICH. We aimed to compare the course of PHE after ICH between patients who received IVF with rtPA and controls matched for ICH volume. METHODS - : Patients were identified retrospectively from our institutional ICH database. Sixty-four patients with ICH and intraventricular hemorrhage who were treated with IVF were compared with 64 controls, who did not receive IVF, matched for ICH volume. The course of PHE was assessed on computed tomography scans (day 1, days 2 and 3, days 4-6, 7-9, and 10-12) using a threshold-based semiautomatic volumetric algorithm. Relative PHE was calculated as a ratio of PHE volume and initial ICH volume. RESULTS - : The matching algorithm resulted in similar mean ICH volumes in both groups (20.01±17.5 mL, IVF vs 20.08±17.1 mL, control). Intraventricular hemorrhage volume was larger in the IVF group (26.8±19.2 mL vs 9.2±13.4 mL). The mean total rtPA dose used for IVF was 8±6 mg. PHE increased over time in both groups until day 12. At all investigated time points, there was no significant difference in relative PHE between the IVF group and controls (F=0.39; P=0.844). CONCLUSIONS - : IVF with rtPA did not lead to a relevant increase in PHE after ICH. rtPA doses used in the current study seem to be safe regarding PHE. © 2013 American Heart Association, Inc.
CRIS-Team Scopus Importer:2022-08-05
Keywords: intracerebral hemorrhage; intraventricular fibrinolysis; intraventricular hemorrhage; perihemorrhagicedema; recombinant tissue-type plasminogen activator; semiautomatic volumetry; X-ray computed tomography

Intraventricular fibrinolysis has no effects on shunt dependency and functional outcome in endovascular-treated aneurysmal SAH - Gerner, Stefan; Kuramatsu, Joji; Abel, Henning; Kloska, Stephan; Lücking, Hannes; Eyüpoglu, Ilker Yasin; Dörfler, Arnd; Schwab, Stefan; Huttner, Hagen (Neurocritical Care, 2014)
Intraventricular fibrinolysis (IVF) in subarachnoid hemorrhage (SAH) is an emerging strategy aiming to hasten clot lysis, treat hydrocephalus, and reduce permanent shunt rates. Because of clinical heterogeneity of investigated patient effects of IVF on permanent shunt incidence and functional outcome are widely debated. The present study is the first to investigate solely endovascular-treated SAH patients.Overall, 88 consecutive patients with aneurysmal SAH requiring external ventricular drain placement and endovascular aneurysm closure were included. Functional outcome and shunt dependency were assessed 90 days after event. A matched controlled sub-analysis was carried out to investigate the effects of IVF treatment (n = 14; matching criteria: age, neuro-status and imaging). Multivariate modeling was performed to identify independent predictors for permanent shunt dependency.In IVF-patients neurological status was significantly poorer [Hunt&Hess: IVF = 4(3-5) vs. non-IVF = 3(1-5); p = 0.035] and the extent of ventricular hemorrhage was increased [Graeb Score: IVF = 7(6-8) vs. non-IVF = 3(1-4); p <= 0.001]. Consecutive matched controlled sub-analysis revealed no significant therapeutic effect of IVF with respect to shunt dependency rate and functional outcome. Multivariate analysis revealed Graeb score [OR = 1.34(1.02-1.76); p = 0.035] and sepsis [OR = 11.23(2.28-55.27); p = 0.003] as independent predictors for shunt dependency, whereas IVF did not exert significant effects (p = 0.820).In endovascular-treated SAH patients IVF neither reduced permanent shunt dependency nor influenced functional outcome. Despite established effects on intraventricular clot resolution IVF appears less powerful in SAH as compared to ICH. Given the reported positive effects of lumbar drainage (LD) in SAH, a prospective analysis of a combined treatment approach of IVF and subsequent lumbar drain sOeems warranted aiming to reduce permanent shunting and improve functional outcome.
EVALuna2:22283

Introduction of a breast apparent diffusion coefficient category system (ADC-B) derived from a large multicenter MRI database - Bickel, Hubert; Clauser, Paola; Pinker, Katja; Helbich, Thomas; Biondic, Iva; Brkljacic, Boris; Dietzel, Matthias; Ivanac, Gordana; Krug, Barbara; Moschetta, Marco; Neuhaus, Victor; Preidler, Klaus; et al. (European Radiology, 2023)
Objectives: To develop an intuitive and generally applicable system for the reporting, assessment, and documentation of ADC to complement standard BI-RADS criteria. Methods: This was a multicentric, retrospective analysis of 11 independently conducted institutional review board–approved studies from seven institutions performed between 2007 and 2019. Breast Apparent Diffusion coefficient (ADC-B) categories comprised ADC-B0 (ADC non-diagnostic), ADC-B1 (no enhancing lesion), and ADC-B2-5. The latter was defined by plotting ADC versus cumulative malignancy rates. Statistics comprised ANOVA with post hoc testing and ROC analysis. p values ≤ 0.05 were considered statistically significant. Results: A total of 1625 patients (age: 55.9 years (± 13.8)) with 1736 pathologically verified breast lesions were included. The mean ADC (× 10−3 mm2/s) differed significantly between benign (1.45, SD.40) and malignant lesions (.95, SD.39), and between invasive (.92, SD.22) and in situ carcinomas (1.18, SD.30) (p <.001). The following ADC-B categories were identified: ADC-B0—ADC cannot be assessed; ADC-B1—no contrast-enhancing lesion; ADC-B2—ADC ≥ 1.9 (cumulative malignancy rate < 0.1%); ADC-B3—ADC 1.5 to < 1.9 (0.1–1.7%); ADC-B4—ADC 1.0 to < 1.5 (10–24.5%); and ADC-B5—ADC < 1.0 (> 24.5%). At the latter threshold, a positive predictive value of 95.8% (95% CI 0.94–0.97) for invasive versus non-invasive breast carcinomas was reached. Conclusions: The breast apparent diffusion coefficient system (ADC-B) provides a simple and widely applicable categorization scheme for assessment, documentation, and reporting of apparent diffusion coefficient values in contrast-enhancing breast lesions on MRI. Clinical relevance statement: The ADC-B system, based on diverse MRI examinations, is clinically relevant for stratifying breast cancer risk via apparent diffusion coefficient measurements, and complements BI-RADS for improved clinical decision-making and patient outcomes. Key Points: • The breast apparent diffusion coefficient category system (ADC-B) is a simple tool for the assessment, documentation, and reporting of ADC values in contrast-enhancing breast lesions on MRI. • The categories comprise ADC-B0 for non-diagnostic examinations, ADC-B1 for examinations without an enhancing lesion, and ADC-B2-5 for enhancing lesions with an increasing malignancy rate. • The breast apparent diffusion coefficient category system may be used to complement BI-RADS in clinical decision-making.
CRIS-Team Scopus Importer:2023-05-26
Keywords: Breast neoplasms; Classification; Diffusion magnetic resonance imaging

Invasiveness and Clinical Outcomes of Off-Hour Admissions in Patients with Intracerebral Hemorrhage - Mrochen, Anne; Sprügel, Maximilian; Gerner, Stefan; Madžar, Dominik; Kuramatsu, Joji; Lücking, Hannes; Schwab, Stefan; Huttner, Hagen; Hölter, Philip (Journal of Stroke and Cerebrovascular Diseases, 2019)
BACKGROUND: Whether time of hospital admission-during or outside regular working hours-affects functional outcome in intracerebral hemorrhage (ICH) is unestablished as previous analyses have focused on mortality only. We here investigate whether on- versus off-hour hospital admission in ICH is associated with levels of invasiveness and clinical outcomes. METHODS: Based on the UKER registry (NCT03183167) we grouped ICH-patients according to on- versus off-hour hospital admission. Primary outcome measures was functional outcome after 3 months using the modified Rankin scale (mRS) dichotomized into favorable (mRS = 0-3) and unfavorable (mRS = 4-6). Multivariate regression analyses were used to adjust for baseline imbalances, and subgroup analyses were performed to explore associations of on- versus off-hour admission with invasiveness of therapeutic interventions. RESULTS: A total of 438/1269 (34.5%) of ICH-patients were admitted during regular working hours. Mortality rates were not significantly different among patients with on- versus off-hour admission. On-hour patients showed a significantly larger proportion of patients with favorable outcome (on-hour: mRS = 0-3 after 3 months: 176/416 (42.3%) versus off-hour: 265/784 (33.8%); P = .004). Analysis of invasive therapeutic interventions revealed that likelihood of favorable outcome was significantly increased among on-hour admitted patients who did not require neurosurgical interventions (no external ventricular drain n = 349, OR: 1.67[1.13-2.48], P < .05; no hematoma evacuation surgery n = 423, OR: 1.51[1.07-2.14], P < .05). CONCLUSION: This study verified an "off-hour effect" in ICH that relates to functional outcome, rather than mortality, and which may be linked to different levels of invasive therapeutic interventions in patients admitted during off-hour.
EVALuna2:206735

Investigation of lateral geniculate nucleus volume and diffusion tensor imaging in patients with normal tension glaucoma using 7 tesla magnetic resonance imaging - Schmidt, Manuel; Knott, Michael; Heidemann, Robin; Michelson, Georg; Kober, Tobias; Dörfler, Arnd; Engelhorn, Tobias (PLoS ONE, 2018)
BACKGROUND: There is evidence that glaucoma is a neurodegenerative disease involving the whole visual pathway. We prospectively examined potential benefits of volumetry of the lateral geniculate nucleus (LGN) and diffusion tensor imaging (DTI) using a new 7T scanner. METHODS: 20 patients with normal tension glaucoma and 16 control individuals were examined. LGN volume and fractional anisotropy (FA) of the optic tract (OT) and the optic radiation (OR) and their correlation with RNFL (retinal nerve fiber layer) thickness were analyzed. RESULTS: LGN volume was significantly reduced in NTG (60.9 vs 88.3; p < 0.05). FA of the OT (right: 0.35 vs 0.66, left: 0.36 vs 0.67; p < 0.05) and of the OR (right: 0.41 vs 0.70, left: 0.41 vs 0.69; p < 0.05) was also significantly reduced. Nasal RNFL thickness correlated with the volume of the contralateral LGN (r = 0.471, p = 0.05). Temporal RNFL thickness correlated with the volume of the ipsilateral LGN (r = 0.603, p = 0.015). CONCLUSION: NTG leads to significant atrophy of the LGN compared to controls. FA of the optic tract and the optic radiation is reduced in NTG as sign of axonal degeneration. RNFL thickness but not FA correlates with LGN volume.
EVALuna2:34502

Investigation of subdural electrode displacement in invasive epilepsy surgery workup using neuronavigation and intraoperative MRI - Sommer, Bjoern; Rampp, Stefan; Dörfler, Arnd; Stefan, Hermann; Hamer, Hajo; Buchfelder, Michael; Roessler, Karl (Neurological Research, 2018)
OBJECTIVES: One of the main obstacles of electrode implantation in epilepsy surgery is the electrode shift between implantation and the day of explantation. We evaluated this possible electrode displacement using intraoperative MRI (iopMRI) data and CT/MRI reconstruction. METHODS: Thirteen patients (nine female, four male, median age 26 ± 9.4 years) suffering from drug-resistant epilepsy were examined. After implantation, the position of subdural electrodes was evaluated by 3.0 T-MRI and thin-slice CCT for 3D reconstruction. Localization of electrodes was performed with the volume-rendering technique. Post-implantation and pre-explantation 1.5 T-iopMRI scans were coregistered with the 3D reconstructions to determine the extent of electrode dislocation. RESULTS: Intraoperative MRI at the time of explantation revealed a relevant electrode shift in one patient (8%) of 10 mm. Median electrode displacement was 1.7 ± 2.6 mm with a coregistration error of 1.9 ± 0.7 mm. The median accuracy of the neuronavigation system was 2.2 ± 0.9 mm. Six of twelve patients undergoing resective surgery were seizure free (Engel class 1A, median follow-up 37.5 ± 11.8 months). CONCLUSION: Comparison of pre-explantation and post-implantation iopMRI scans with CT/MRI data using the volume-rendering technique resulted in an accurate placement of electrodes. In one patient with a considerable electrode dislocation, the surgical approach and extent was changed due to the detected electrode shift. ABBREVIATIONS: ECoG: electrocorticography; EZ: epileptogenic zone; iEEG: invasive EEG; iopMRI: intraoperative MRI; MEG: magnetoencephalography; PET: positron emission tomography; SPECT: single photon emission computed tomography; 3D: three-dimensional.
EVALuna2:201939

In vivo assessment of cold stimulation effects on the fat fraction of brown adipose tissue using DIXON MRI - Stahl, Vanessa; Maier, Florian; Freitag, Martin T.; Floca, Ralf O.; Berger, Moritz C.; Umathum, Reiner; Diaz, Mauricio Berriel; Herzig, Stephan; Weber, Marc-Andre; Dimitrakopoulou-Strauss, Antonia; Rink, Kristian; Bachert, Peter; et al. (Journal of Magnetic Resonance Imaging, 2017)
To evaluate the volume and changes of human brown adipose tissue (BAT) in vivo following exposure to cold using magnetic resonance imaging (MRI).The clavicular region of 10 healthy volunteers was examined with a 3T MRI system. One volunteer participated twice. A cooling vest that was circulated with temperature-controlled water was used to expose each volunteer to a cold environment. Three different water temperature phases were employed: baseline (23°C, 20 min), cooling (12°C, 90 min), and a final warming phase (37°C, 30 min). Temperatures of the water in the circuit, of the body, and at the back skin of the volunteers were monitored with fiberoptic temperature probes. Applying the 2-point DIXON pulse sequence every 5 minutes, fat fraction (FF) maps were determined and evaluated over time to distinguish between brown and white adipose tissue.Temperature measurements showed a decrease of 3.8 ± 1.0°C of the back skin temperature, while the body temperature stayed constant at 37.2 ± 0.9°C. Focusing on the two interscapular BAT depots, a mean FF decrease of -2.9 ± 2.0%/h (P < 0.001) was detected during cold stimulation in a mean absolute volume of 1.31 ± 1.43 ml. Also, a correlation of FF decrease to back skin temperature decrease was observed in all volunteers (correlation coefficients: |r| = [0.51; 0.99]).We found that FF decreases in BAT begin immediately with mild cooling of the body and continue during long-time cooling.2 J. Magn. Reson. Imaging 2017;45:369-380.
EVALuna2:14664

In Vivo Brain Sodium Disequilibrium in ATP1A3-Related Rapid-Onset Dystonia-Parkinsonism - Prasuhn, Jannik; Gottlich, Martin; Grosser, Sinja S.; Reuther, Katharina; Ebeling, Britt; Munchau, Alexander; Nagel, Armin Michael; Bruggemann, Norbert (Movement Disorders, 2022)
CRIS-Team WoS Importer:2022-02-18

In vivo potassium MRI of the human heart - Wenz, Daniel; Nagel, Armin Michael; Lott, Johanna; Kuehne, Andre; Niesporek, Sebastian Christian; Niendorf, Thoralf (Magnetic Resonance in Medicine, 2019)
Purpose Potassium ions (K+) play a critical role in cardiac electrophysiology, and changes in their concentration reflect pathophysiological processes related to cardiovascular diseases. Here, we investigated the feasibility of in vivo K-39 MRI of the human heart. To achieve this, we developed, evaluated, and applied a K-39/H-1 RF coil, which is tailored for K-39 MRI of human heart at 7.0T. Methods The performance of the K-39/H-1 RF coil was evaluated by electromagnetic field and specific absorption ratio simulations using 2 (male/female) human voxel models. The RF coil was evaluated at the bench and applied in an in vivo proof-of-principle study involving 7 healthy volunteers. The experiments were performed using a 7.0T whole-body MR system in conjunction with a 3D density-adapted projection reconstruction imaging technique. Results For in vivo K-39 MRI of the human heart, a nominal spatial resolution of 14.5 x 14.5 x 14.5 mm(3) within a total scan time of 30 min was achieved. The average SNR within the heart was 9.6 +/- 2.4. Conclusion This work validates the design of a K-39/H-1 RF coil for cardiac MR at 7.0T and demonstrates for the first time in vivo the feasibility of K-39 MRI of the human heart.
CRIS-Team WoS Importer:2019-09-17

In vivo proof-of-concept for two experimental antiviral drugs, both directed to cellular targets, using a murine cytomegalovirus model - Sonntag, Eric; Hahn, Friedrich; Bertzbach, Luca D.; Seyler, Lisa; Wangen, Christina; Müller, Regina; Tannig, Pierre; Grau, Benedikt; Baumann, Matthias; Zent, Eldar; Zischinsky, Gunther; Eickhoff, Jan; et al. (Antiviral Research, 2019)
Infections with the human cytomegalovirus (HCMV) cause serious medical problems including organ rejection and congenital infection. Treatment of HCMV infections with currently available medication targeting viral enzymes is often accompanied with severe side effects and the occurrence of drug-resistant viruses. This demands novel therapeutical approaches like targeting genetically stable host cell proteins that are crucial for virus replication. Although numerous experimental drugs with promising in vitro efficacy have been identified, the lack of available data in animal models limits their potential for further clinical development. Recently, we described the very strong in vitro antiherpesviral activity of the NF-κB inhibitor TF27 and the CDK7 inhibitor LDC4297 at low nanomolar concentrations. In the present study, we present first data for the in vivo efficacy of both experimental drugs using an established cytomegalovirus animal model (murine CMV replication in immunodefective Rag −/− mice). The main findings of this study are (i) a strong inhibitory potency against beta- and gamma-herpesviruses of both compounds in vitro, (ii) even more important, a pronounced anticytomegaloviral activity also exerted in vivo, that resulted from (iii) a restriction of viral replication to the site of infection, thus preventing organ dissemination, (iv) in the absence of major compound-associated adverse events. Thus, we provide evidence for a strong antiviral potency in vivo and proof-of-concept for both drugs, which may encourage their further drug development, possibly including pharmacologically optimized derivatives, for a potential use in future antiherpesviral treatment.
CRIS-Team Scopus Importer:2019-12-31
Keywords: Antiviral drug development; Antiviral experimental drugs; Artemisinin and pyrazolotriazine compounds; Herpesviral in vitro/vivo models; Human and murine cytomegaloviruses; Proof-of-concept

In vivo self-gated 23 Na MRI at 7 T using an oval-shaped body resonator - Platt, Tanja; Umathum, Reiner; Fiedler, Thomas M.; Nagel, Armin Michael; Bitz, Andreas K.; Maier, Florian; Bachert, Peter; Ladd, Mark E.; Wielpuetz, Mark O.; Kauczor, Hans-Ulrich; Behl, Nicolas G. R. (Magnetic Resonance in Medicine, 2018)
PURPOSE: This work faces three challenges of sodium (23 Na) torso MRI on the way to quantitative 23 Na MRI: Development of a 23 Na radiofrequency transmit and receive coil covering a large part of the human body in width and length for 23 Na MRI at 7 T; reduction of blurring due to respiration in free-breathing 23 Na MRI using a self-gating approach; and reduction of image noise using a compressed-sensing reconstruction. METHODS: An oval-shaped birdcage resonator with a large field of view of (400 mm)3 and a homogeneous transmit and receive field distribution was designed, simulated, and implemented on a 7T MR system. In free-breathing 3-dimensional radial 23 Na MRI (acquisition time ≈ 30 minutes), retrospective respiratory self-gating was applied, which sorts the acquired projections into two respiratory states based on the intrinsic respiration-dependent signal changes. Furthermore, a 3-dimensional dictionary-learning compressed-sensing reconstruction was applied. RESULTS: The developed body coil provided homogeneous radiofrequency excitation (flip angle error of 4.9% in central region of interest of 23 × 13 × 10 cm3 ) and homogeneous signal reception. The self-gating approach allowed for separation of the full data set into two subsets associated with different respiratory states (inhaled and exhaled), and thereby reduced blurring due to respiration in the separated images. Image noise was markedly reduced by the compressed-sensing algorithm. CONCLUSION: The presented body coil enables full body width 23 Na MRI with long z-axis coverage at 7 T for the first time. Additionally, the retrospective respiratory self-gating performance is demonstrated for free-breathing lung and abdominal 23 Na MRI in 3 subjects.
EVALuna2:36239

Involvement of radiologists in oncologic multidisciplinary team meetings: an international survey by the European Society of Oncologic Imaging - Neri, Emanuele; Gabelloni, Michela; Bäuerle, Tobias; Beets-Tan, Regina; Caruso, Damiano; D’Anastasi, Melvin; Dinkel, Julien; Fournier, Laure S.; Gourtsoyianni, Sofia; Hoffmann, Ralf Thorsten; Mayerhöfer, Marius Erik; Regge, Daniele; et al. (European Radiology, 2020)
Objectives: Multidisciplinary tumour boards (MTBs) play an increasingly important role in managing cancer patients from diagnosis to treatment. However, many problems arise around the organisation of MTBs, both in terms of organisation-administration and time management. In this context, the European Society of Oncologic Imaging (ESOI) conducted a survey among its members, aimed at assessing the quality and amount of involvement of radiologists in MTBs, their role in it and related issues. Methods: All members were invited to fill in a questionnaire consisting of 15 questions with both open and multiple-choice answers. Simple descriptive analyses and graphs were performed. Results: A total of 292 ESOI members in full standing for the year 2018 joined the survey. Most respondents (89%) declared to attend MT-Bs, but only 114 respondents (43.9%) review over 70% of exams prior to MTB meetings, mainly due to lack of time due to a busy schedule for imaging and reporting (46.6%). Perceived benefits (i.e. surgical and histological feedback (86.9%), improved knowledge of cancer treatment (82.7%) and better interaction between radiologists and referring clinicians for discussing rare cases (56.9%)) and issues (i.e. attending MTB meetings during regular working hours (71.9%) and lack of accreditation with continuing medical education (CME) (85%)) are reported. Conclusions: Despite the value and benefits of radiologists’ participation in MTBs, issues like improper preparation due to a busy schedule and no counterpart in CME accreditation require efforts to improve the role of radiologists for a better patient care. Key Points: • Most radiologists attend multidisciplinary tumour boards, but less than half of them review images in advance, mostly due to time constraints. • Feedback about radiological diagnoses, improved knowledge of cancer treatment and interaction with referring clinicians are perceived as major benefits. • Concerns were expressed about scheduling multidisciplinary tumour boards during regular working hours and lack of accreditation with continuing medical education.
CRIS-Team Scopus Importer:2020-09-04
Keywords: Interdisciplinary communication; Medical oncology; Radiologists; Surveys and questionnaires

iPad-based patient briefing for radiological examinations-a clinical trial - Schlechtweg, Philipp; Hammon, Matthias; Giese, David Andreas; Heberlein, Christian; Uder, Michael; Schwab, Siegfried (Journal of Digital Imaging, 2014)
To analyze if an iPad-based patient briefing can serve as a digital alternative to conventional documentations prior to radiological examinations. One hundred one patients referred for routine MRI were randomized into two groups, who underwent iPad-based and classic written briefing in opposite order. For each briefing completion time, completeness and correctness were noted. Patient's knowledge about the content of either briefing modality was subsequently tested. The influence of patient-related factors on the performance of the electronic briefing (EB) was analyzed. Finally, the patient's subjective impression of the EB was assessed. The mean durations were 4.4 ± 2.2 min for EB and 1.7 ± 1.3 min for the classic briefing (p < 0.01). All iPad briefings were returned entirely filled out, whereas 11 % of the classic forms were returned with missing data. No significant differences in memorization of the briefing's information were objectified. There was a positive correlation between the duration of EB and age (r = 0.53; p < 0.01), whereas a negative correlation was found between computer skills and patient's age (r = -0.55; p < 0.01) or duration of EB (r = -0.62; p < 0.01). More than half of the study patients would prefer EB in the future; another 29 % had no preference at all. Patient briefing on iPads transfers the information for the patients equally well compared to the classic written approach. Although iPad briefing took patients longer to perform, the majority would prefer it to written consent briefings in the future. Nevertheless, measures have to be undertaken to improve the overall acceptance and performance.
EVALuna2:14372

iPads in Breast Imaging - A Phantom Study - Hammon, Matthias; Schlechtweg, Philipp; Schulz-Wendtland, Rüdiger; Uder, Michael; Schwab, Sibylle (Geburtshilfe und Frauenheilkunde, 2014)
Introduction: Modern tablet PCs as the iPad are becoming more and more integrated into medicine. The aim of this study was to evaluate the display quality of iPads regarding digital mammography. Materials and Methods: Three experienced readers compared the display quality of the iPad 2 and 3 with a dedicated 10 megapixel (MP) mammography liquid crystal display (LCD) screen in consensus using the standardized Contrast Detail Mammography (CDMAM) phantom. Phantom fields without agreement between the readers were classified as "uncertain", correct 2 : 1 decisions were classified as "uncertain/readable". In a second step display quality of the three reading devices was judged subjectively in a side by side comparison. Results: The 10 MP screen was superior to both iPads in 4 (phantom-)fields and inferior in 2 fields. Comparing the iPads, version 3 was superior in 4 fields and version 2 was superior in 1 field. However these differences were not significant. Total number of "uncertain" fields did not show significant differences. The number of "uncertain" fields was 15 with the 10 MP screen, 16 with the iPad 2 and 17 with the iPad 3 (p > 0.05), the number of "uncertain/readable" fields was 4, 7 and 8, respectively. Subjective image quality of the iPad 3 and the 10 MP screen was rated superior to the iPad 2. Conclusion: The evaluated iPads, especially in version 3, seem to be adequate to display mammograms in a diagnostic quality and thus could be useful e.g. for patient consultation, clinical demonstration or educational and teaching purposes. However primary mammogram reading should still be performed on dedicated large sized reading screens.
EVALuna2:14368

Ischaemic stroke and Clostridium septicum sepsis and meningitis in a patient with occult colon carcinoma - a case report and review of the literature - Macha, Kosmas; Giede-Jeppe, Antje; Lücking, Hannes; Coras, Roland; Huttner, Hagen; Held, Jürgen (BMC Neurology, 2016)
Clostridium septicum is a rare cause of meningitis and brain abscess in children and adults. Gas production by the pathogen can lead to pneumocephalus and the overall mortality rate of Clostridium septicum CNS infection is as high as 74%. The most common entry site of the pathogen is the gastrointestinal tract.We describe a 74-year-old man who presented with a left-sided cerebral infarction in the middle cerebral artery territory. In addition the patient showed signs of Systemic Inflammatory Response Syndrome and Disseminated Intravascular Coagulation. Examination of blood cultures and cerebrospinal fluid led to the diagnosis of sepsis and meningitis caused by Clostridium septicum. Despite appropriate antibiotic therapy the condition of the patient deteriorated rapidly and he died on day 2 after admission. Autopsy revealed a previously unknown adenocarcinoma of the colon ascendens as entry site of the pathogen.Clostridium septicum should be considered as potential pathogen in patients with sepsis and meningitis. Gram stain morphology in conjunction with severe sepsis can rapidly point into the direction of this pathogen. CNS infections manifest either as meningoencephalitis/cerebritis or as brain abscess. Entry site of the pathogen is almost uniquely the gastrointestinal tract. In adults more than 50% suffer from colorectal carcinoma, therefore survivors of Clostridium septicum infections should be examined for underlying occult colorectal malignancy.
EVALuna2:7346

Ischemic stroke associated with the use of a synthetic cannabinoid (spice) - Möller, Sebastian; Luecke, Caroline; Struffert, Tobias; Schwarze, Bernhard; Gerner, Stefan; Schwab, Stefan; Köhrmann, Martin; Machold, Kristin; Philipsen, Alexandra; Mueller, Helge H. (Asian Journal of Psychiatry, 2017)
Synthetic cannabinoids, i.e. "spice", are psychoactive drugs with increasing use worldwide. Spice may have harmful neuropsychiatric and physical side effects. Here, we present the case of a 25-year-old man with ischemic stroke after smoking spice on the previous evening. Diagnostic work-up was negative for other common causes of stroke. Toxicology screen unveiled the cannabimimetic ADB-FUBINACA in the drug sample and in patient's urine. The cardiac sympathomimetic effect of spice might have triggered an unnoticed episode of tachyarrhythmia and resulted in stroke via cardioembolic etiology. Thus, in absence of other risk factors, a careful patient history of spice use is recommended for patients with acute neurological deficits.
EVALuna2:22545

Is Hypothermia Helpful in Severe Subarachnoid Hemorrhage? An Exploratory Study on Macro Vascular Spasm, Delayed Cerebral Infarction and Functional Outcome after Prolonged Hypothermia - Kuramatsu, Joji; Kollmar, Rainer; Gerner, Stefan; Madzar, Dominik; Pisarcikova, Andrea; Staykov, Dimitre; Kloska, Stephan; Dörfler, Arnd; Eyüpoglu, Ilker Yasin; Schwab, Stefan; Huttner, Hagen (Cerebrovascular Diseases, 2015)
Therapeutic hypothermia (TH) is an established treatment after cardiac arrest and growing evidence supports its use as neuroprotective treatment in stroke. Only few and heterogeneous studies exist on the effect of hypothermia in subarachnoid hemorrhage (SAH). A novel approach of early and prolonged TH and its influence on key complications in poor-grade SAH, vasospasm and delayed cerebral ischemia (DCI) was evaluated.This observational matched controlled study included 36 poor-grade (Hunt and Hess Scale >3 and World Federation of Neurosurgical Societies Scale >3) SAH patients. Twelve patients received early TH (<48 h after ictus), mild (35°C), prolonged (7 ± 1 days) and were matched to 24 patients from the prospective SAH database. Vasospasm was diagnosed by angiography, macrovascular spasm serially evaluated by Doppler sonography and DCI was defined as new infarction on follow-up CT. Functional outcome was assessed at 6 months by modified Rankin Scale (mRS) and categorized as favorable (mRS score 0-2) versus unfavorable (mRS score 3-6) outcome.Angiographic vasospasm was present in 71.0% of patients. TH neither influenced occurrence nor duration, but the degree of macrovascular spasm as well as peak spastic velocities were significantly reduced (p < 0.05). Frequency of DCI was 87.5% in non-TH vs. 50% in TH-treated patients, translating into a relative risk reduction of 43% and preventive risk ratio of 0.33 (95% CI 0.14-0.77, p = 0.036). Favorable functional outcome was twice as frequent in TH-treated patients 66.7 vs. 33.3% of non-TH (p = 0.06).Early and prolonged TH was associated with a reduced degree of macrovascular spasm and significantly decreased occurrence of DCI, possibly ameliorating functional outcome. TH may represent a promising neuroprotective therapy possibly targeting multiple pathways of DCI development, notably macrovascular spasm, which strongly warrants further evaluation of its clinical impact.
EVALuna2:22357

Is Laminar Cartilage Composition as Determined by T2 Relaxometry Associated with Incident and Worsening of Cartilage or Bone Marrow Abnormalities? - Roemer, Frank; Eckstein, Felix; Duda, Georg; Guermazi, Ali; Maschek, Susanne; Sharma, Leena; Wirth, Wolfgang (Cartilage, 2020)
Objective: To test the hypothesis that superficial cartilage composition (T2) is associated with subsequent incidence or worsening of cartilage damage, and deep T2 with that of bone marrow lesions (BMLs) in knees without radiographic osteoarthritis (ROA). Design: A total of 201 knees from the Osteoarthritis Initiative without ROA were included: 78 from the healthy reference cohort, 60 without ROA but with risk factors, and 63 without ROA but with contralateral ROA. Year 1 (Y1) superficial and deep cartilage T2 were derived in the medial and lateral (weightbearing) femur (MF/LF) and tibia (MT/LT), using sagittal multiecho spin echo magnetic resonance images. Cartilage and BMLs were assessed in the medial (MFTJ) and lateral femorotibial joint (LFTJ) at Y1 and 3 years later. Binary logistic regression statistics were applied. Results: Incidence or worsening of cartilage damage was more frequent (MFTJ 15%, LFTJ 13%) than incidence or worsening of BMLs (6.0%, 4.5%). In knees with incident or worsening cartilage lesions in the MF and LT, deep layer T2 in the same plate was elevated (MF, 43.6 ± 4.0 vs. 41.3 ± 3.8 ms, P = 0.047; LT, 33.8 ± 2.3 vs. 32.0 ± 2.2 ms, P = 0.008) compared to those without. In knees with incident or worsening of BMLs in the LFTC and LT, superficial layer T2 was elevated (LFTJ, 49.6 ± 4.8 vs. 46.7 ± 3.1 ms; LT, 47.4 ± 4.9 vs. 44.0 ± 3.3 ms, both Ps = 0.04). Conclusions: Contrary to our hypothesis, increased deep layer cartilage T2 was associated with subsequent worsening of cartilage damage, whereas superficial layer T2 was related to subsequent BML worsening. Yet, this relationship was observed in some, but not in all cartilage plates.
CRIS-Team Scopus Importer:2020-06-19
Keywords: MRI; osteoarthritis; progression; risk factors

IS MENISCAL DAMAGE IN THE ANTERIOR CRUCIATE LIGAMENT INJURED KNEE ASSOCIATED WITH EARLY BONE SHAPE CHANGES? AN EXPLORATORY ANALYSIS OF THE KANON TRIAL - Snoeker, B.; Turkiewicz, A.; Bowes, M.; Roemer, Frank; Lohmander, S.; Frobell, R.; Englund, M. (OSTEOARTHRITIS AND CARTILAGE, 2020)
CRIS-Team WoS Importer:2020-06-02

Is Meniscal Status in the Anterior Cruciate Ligament Injured Knee Associated with Change in Bone Surface Area? An Exploratory Analysis of Data from the KANON Trial - Snoeker, Barbara; Turkiewicz, Aleksandra; Bowes, Mike; Roemer, Frank; Lohmander, Stefan; Frobell, Richard; Englund, Martin (ARTHRITIS & RHEUMATOLOGY, 2020)
CRIS-Team WoS Importer:2021-01-15

Is meniscal status in the anterior cruciate ligament injured knee associated with change in bone surface area? An exploratory analysis of the KANON trial - Snoeker, B. A.M.; Bowes, M. A.; Roemer, Frank; Turkiewicz, A.; Lohmander, L. S.; Frobell, R. B.; Englund, M. (Osteoarthritis and Cartilage, 2021)
Objectives: To study bone shape changes as a potential early feature of post-traumatic structural knee OA development, we estimated the association between meniscal status in the anterior cruciate ligament (ACL) injured knee and longitudinal condyle changes in bone surface area. Design: We used data from the KANON trial, including 121 young ACL-injured adults. We obtained baseline and 2-year follow-up knee MRIs. Our outcome was change in the bone surface areas (mean mm2, log-transformed) in 4 locations (femur, tibia, patella, and trochlea femur) in the medial and lateral compartment from baseline to 2 years. Meniscal pathology was defined as both present at baseline and newly developed (i.e., incident or progressed) using ACLOAS. We used multilevel linear regression adjusted for baseline bone area, age, sex, body mass index, treatment arm (i.e., early or optional delayed ACL reconstruction), and location. We analyzed medial and lateral compartment separately. We present results as percentage (%) bone area change difference with 95% confidence intervals (CI). Results: We analyzed 109 subjects (median 27 (18–36) years, 83% men) due to missing MRI information. The bone surface area increased on average by ∼2% over 2 years. The differences between knees with and without baseline meniscal pathology were 1.1% (95%CI 0.0–2.3%) and 1.4% (95%CI 0.6–2.2%) in the medial and lateral compartment, respectively, and 1.2% (95%CI 0.3–2.0%) and 1.3% (95%CI 0.6–2.0%) for medial and lateral newly developed pathology, respectively. Conclusion: Our finding of ∼1% increase bone area in compartment with meniscal pathology suggests a potentially important association between meniscal integrity and early bone surface area changes after ACL injury. Trial registration number ISRCTN 84752559.
CRIS-Team Scopus Importer:2021-04-02
Keywords: Anterior cruciate ligament; Bone surface area changes; Meniscus; Osteoarthritis

Isolated meningomyeloradiculitis following infection with tick borne encephalitis virus - Racz, Attila; Schaller, Gerd; Lunkenheimer, Jens; Engelhorn, Tobias; Dörfler, Arnd; Sperling, Wolfgang; Schwab, Stefan; Maihöfner, Christian (Clinical Neurology and Neurosurgery, 2012)
CRIS-Team Scopus Importer:2022-08-05
Keywords: Meningomyeloradiculitis; Myelitis; Polyradiculitis; Tick borne encephalitis virus

Isolated testicular pain mimicking ruptured abdominal aortic aneurysm in a nonagenarian - Regus, Susanne; Apel, Hendrik; Dankerl, Peter; Lang, Werner (American Journal of Emergency Medicine, 2015)
Ruptured abdominal aortic aneurysm commonly presents as acute abdominal or lower back pain and hemodynamic instability. We discuss the case of a 90-year-old patient who presented to the emergency unit with a 3-day history of left testicular pain. Ultrasound scan demonstrated and a computed tomography scan confirmed a 6 cm in diameter ruptured abdominal aortic aneurysm with enlargement and hematoma of the left psoas muscle causing the symptoms. This atypical presentation highlights the need for clinical vigilance and emergency physician-performed ultrasound scan in the older patients with seemingly benign testicular symptoms.
EVALuna2:14469

Isolated Unilateral Strabismus Sursoadductorius (Congenital Trochlear Palsy) with and without Hypotrophia of the Superior Oblique Muscle-Orthoptic Differences in Adulthood - Gusek-Schneider, Gabriele-Charlotte; Kaestle, Nicola; Reil, Franziska; Schuerhoff, Sabine; Engelhorn, Tobias (Klinische Monatsblätter für Augenheilkunde, 2018)
PURPOSE: The clinical feature of unilateral decompensating strabismus sursoadductorius (dSSA; often called congenital superior oblique palsy, CSOP) is not an etiologically uniform entity. Hypotrophy of the superior oblique muscle (HMOS) is a frequent and immediate cause of dSSA/CSOP. In this study, clinical characteristics of dSSA/CSOP with and without HMOS are compared. PATIENTS AND METHODS: Twenty-five consecutive patients (age 14 - 69 years; median 43 years) were included in this study, 14 with 3T MRI-proven HMOS (group 1) and 11 without HMOS (group 2). HMOS was defined as a reduction of the medio-lateral (ML) as well as based on ML and cranio-caudal (CC) diameter calculated area = (ML · CC/4) · π of the affected superior oblique muscle (SOM) < 80% in comparison to the contralateral SOM (measured on the single coronal image on which the muscle has its greatest extent). The two groups were compared in terms of head tilt, cyclo- and vertical deviation and the Bielschowsky head tilt test. Patients were classified according the Knapp's classification. RESULTS: Both the incidence of head tilt with 14/14 vs. 5/11 (χ2 = 0.003) and its degree: 11.1 ± 4.5° vs. 3.2 ± 4.1° (p < 0.001) was higher in group 1 than in group 2, as well as the Bielschowsky head tilt test: 9.3 ± 4.3° vs. 3.8 ± 4.9° (p = 0.008). The average amount of hypertropia was larger in group 1 than in group 2 during adduction: 16.7 ± 5.3° vs. 9.3 ± 3.4° (p < 0.001) as well as during adduction and downgaze of the affected eye: 14.6 ± 7.1 vs. 7.2 ± 3.7° (p = 0.03). In the sagittal plane, the increase of vertical deviation was larger in group 1 than in group 2: 2.8 ± 7.8 vs. - 2.4 ± 4.2 (p = 0.04); the excyclodeviation was larger in group 1 in all three planes (sagittal plane, adduction and abduction) in comparison to group 2: 1.3 ± 4.1 vs. - 2.9 ± 2.8 (p = 0.006), 2.4 ± 5.2 vs. - 2.2 ± 2.9 (p = 0.01), 0.5 ± 3.8 vs. - 2.7 ± 3.9 (p = 0.05). Knapp's class II was found in 6 of 15 patients in group 1 and only in this patient group (χ2 = 0.03). CONCLUSIONS: In both groups, the vertical deviation showed a great dispersion. In patients without HMOS (group 2), vertical deviation in adduction did not exceed 15°. Patients with HMOS (group 1) do not show the typical features of a later acquired trochlear palsy due to an early developed compensating innervation. A vertical deviation in adduction of more than 15°, increasing excyclodeviation towards downgaze in all three planes (sagittal plane, adduction and abduction) and Knapp's class II are relatively reliable predictors of a hypoplasia of the SOM. An internationally uniform term for this group of patients, such as superior oblique weakness or superior oblique hypotrophy, would be desirable.
EVALuna2:34915

Isotropic reconstruction of SPECT data using OSEM3D: Correlation with CT - Römer, Wolfgang; Reichel, Nicky; Vija, Hans; Nickel, Ingo; Hornegger, Joachim; Bautz, Werner; Kuwert, Torsten (Academic Radiology, 2006)
Rationale and Objectives. A statistical based iterative single-photon emission-computed tomography (SPECT) reconstruction algorithm (OSEM) modeling the depth-dependent collimator response in three dimensions has recently been introduced (OSEM3D). The aim of this study was to evaluate the axial shape fidelity of OSEM3D in comparison to OSEM, not taking this variable into account (OSEM2D). Materials and Methods. SPECT and separate spiral CT were performed in a phantom containing spheres filled with In-111. In-111-pentetreotide-SPECT and separate spiral-CT imaging were also performed in 22 patients with neuroendocrine tumors. Using window settings adapting the transversal size of the SPECT hot spots to that on CT and the 50% isocontour as boundary, the three-dimensional extensions (dx, dy, dz) of the SPECT representation of the structures under study were measured. These variables were also determined for CT. Furthermore, an index of eccentricity was calculated by averaging the ratios between dz and dx and dz and dy (IE). For isotropically imaged spheres, IE is 1. Results. For OSEM2D, IE was significantly different from 1 in the phantom data (P < .05); this was not the case for OSEM3D and CT. This finding was accounted for by a significantly greater dz on the OSEM2D-SPECT images. In the patient data, dz was by approximately 15.5% greater for OSEM2D than for the other two modalities (P < .05). Conclusions. The use of OSEM3D avoids deformation of hot SPECT lesions in z-direction. This may be of particular importance in SPECT/CT hybrid imaging capitalizing on the exact match of both modalities. © AUR, 2006.

Is "prepectoral edema" a morphologic sign for malignant breast tumors? - Kaiser, Clemens G.; Herold, Michael; Baltzer, Pascal A. T.; Dietzel, Matthias; Krammer, Julia; Gajda, Mieczyslaw; Camara, Oumar; Schoenberg, Stefan O.; Kaiser, Werner A.; Wasser, Klaus (Academic Radiology, 2015)
A variety of morphologic and kinetic signs of benign or malignant breast lesions contribute to a final diagnosis and differential diagnosis in magnetic resonance (MR) mammography (MRM). As a new sign, prepectoral edema (PE) in patients without any history of previous biopsy, operation, radiation, or chemotherapy was detected during routine breast MR examinations. The purpose of this study was to retrospectively evaluate the role of this morphologic sign in the differential diagnosis of breast lesions.Between January 2005 and October 2006, a total of 1109 consecutive MRM examinations have been performed in our institution. In this study, only patients who would later be biopsied or operated in our own hospital were included. They had no previous operation, biopsy, intervention, chemotherapy, hormone replacement therapy, or previous mastitis. In total, 162 patients with 180 lesions were included, histologically correlated later-on by open biopsy (124 patients and 136 lesions) or core biopsy (38 patients and 44 lesions). The evaluations were performed by four experienced radiologists in consensus.One hundred eighty evaluated lesions included 104 malignant lesions (93 invasive and 11 noninvasive cancers) and 76 benign lesions. PE was detected in 2.6% of benign lesions (2 of 76), in none of the Ductal cacinoma in situ (DCIS) cases (0 of 11), and in 25.8% of malignant lesions (24 of 93; P < .000). PE was found significantly more frequently in presence of malignant tumors >2 cm in diameter (48.5%, 17 of 35 vs. 13.8%, 8 of 58; P < .001). PE was not statistically associated to malignant tumor type, presence or absence of additional DCIS, and number of lesions. This resulted in the following diagnostic parameters for PE as an indicator for malignancy: sensitivity of 19.3%, specificity of 97.3%, positive predictive value (PPV) of 92.3%, negative predictive value of 48%, and accuracy of 57.7%.In case of occurrence, the "PE sign" seems to be a specific indicator for malignant tumors with a high PPV, independent from its entity.
EVALuna2:23002

Is superolateral Hoffa's fat pad hyperintensity a marker of local patellofemoral joint disease? - The MOST study - Jarraya, M.; Guermazi, Ali; Felson, D. T.; Roemer, Frank; Nevitt, M. C.; Torner, J.; Lewis, C. E.; Stefanik, J. J. (Osteoarthritis and Cartilage, 2017)
To determine the relation of superolateral Hoffa's fat pad (SHFP) hyperintensity to cartilage damage and bone marrow lesions (BMLs) in the patellofemoral joint (PFJ) and tibiofemoral joint (TFJ).We used data from the 60 and 84-month study visits from the Multicenter Osteoarthritis (MOST) study. SHFP hyperintensity and Hoffa-synovitis were graded from 0 to 3. Cartilage damage and BMLs were scored in the PFJ and TFJ. Structural damage was defined as: any cartilage damage, full-thickness cartilage damage and any BML. Worsening structural damage was defined as any increase in cartilage and BML scores. Logistic regression was used to determine the relation of SHFP hyperintensity and Hoffa-synovitis (>0) to structural damage, adjusting for age, sex and body mass index (BMI).1,094 knees were included in the study. Compared to knees without SHFP hyperintensity, those with SHFP hyperintensity had 1.2 (95% Confidence Interval (CI), 1.1-1.4), 1.7 (1.3-2.3) and 1.6 (1.3-1.9) times the prevalence of any cartilage damage, full-thickness cartilage damage, and BMLs in the lateral PFJ respectively, and 1.1 (1.0-1.2), 1.3 (1.0-1.8), and 1.2 (1.0-1.4) times the prevalence of any cartilage damage, full-thickness cartilage damage, and BMLs in the medial PFJ. SHFP hyperintensity was associated with worsening BMLs in the medial PFJ (RR: 1.4 (1.0-1.9)). In general, there was no relation between SHFP hyperintensity and TFJ outcomes. Hoffa-synovitis was associated both cross-sectionally and longitudinally with structural damage, regardless of definition, in all compartments.SHFP hyperintensity may be a local marker of PFJ structural damage.
EVALuna2:14715

Is synovitis detected on non-contrast-enhanced magnetic resonance imaging associated with serum biomarkers and clinical signs of effusion? Data from the Osteoarthritis Initiative - Deveza, L. A.; Kraus, V. B.; Collins, J. E.; Guermazi, A.; Roemer, Frank; Nevitt, M. C.; Hunter, D. J. (Scandinavian Journal of Rheumatology, 2018)
OBJECTIVES: To determine the relationship between synovitis detected on non-contrast-enhanced (non-CE) magnetic resonance imaging (MRI), biochemical markers of inflammation, and clinical assessment of effusion in people with knee osteoarthritis (OA). METHOD: We examined data from the OA Biomarkers Consortium within the Osteoarthritis Initiative (n = 600). Non-CE MRIs were semi-quantitatively scored (grades 0-3) for severity of Hoffa synovitis and effusion synovitis. Serum (s) matrix metalloproteinase-3 (sMMP-3), hyaluronic acid (sHA), and nitrated epitope of the α-helical region of type II collagen (sColl2-1NO2) were quantified. The bulge and patellar tap clinical tests were performed at baseline and performance characteristics were assessed for the detection of effusion synovitis on MRI. Multinomial logistic regression adjusted for covariates was used to assess the association between biochemical and imaging markers at baseline and over 12 and 24 months. RESULTS: At baseline, sHA and sMMP-3 were associated with moderate to large (score ≥ 2, n = 117) effusion synovitis, with odds ratio = 1.35 and 1.30 per 1 standard deviation in biochemical markers (95% confidence intervals 1.07, 1.71 and 1.00, 1.69), c-statistics 0.640 and 0.626, respectively. The c-statistics for the presence of Hoffa synovitis (score ≥ 2) were 0.693, 0.694, and 0.694 for sHA, sMMP-3, and sColl2-1NO2, respectively. There was no significant association between biochemical markers (baseline and 12 and 24 month time-integrated concentrations) and changes in MRI markers. The bulge and patellar tap signs were 22.0% and 4.3% sensitive and 88.8% and 94.8% specific, respectively, for detecting effusion synovitis (score ≥ 1) on MRI. CONCLUSIONS: sHA and sMMP-3 were modestly associated with effusion synovitis at baseline. Clinical signs of effusion are insensitive but highly specific for the presence of any effusion synovitis on non-CE MRI.
EVALuna2:36264

Is the atrophic phenotype of tibiofemoral osteoarthritis associated with faster progression of disease? The MOST study - Crema, M. D.; Felson, D. T.; Guermazi, Ali; Nevitt, M. C.; Niu, J.; Lynch, J. A.; Marra, M. D.; Torner, J.; Lewis, C. E.; Roemer, Frank (Osteoarthritis and Cartilage, 2017)
To assess the associations of atrophic tibiofemoral osteoarthritis (OA) with progression of radiographic joint space narrowing (JSN) and magnetic resonance imaging (MRI)-defined progression of cartilage damage.Participants of the Multicenter Osteoarthritis (MOST) Study with available radiographic and MRI assessments at baseline and 30 months were included. The atrophic OA phenotype was defined as Osteoarthritis Research Society International (OARSI) grades 1 or 2 for JSN and grade 0 for osteophytes. Based on MRI, atrophic OA was defined as tibiofemoral (TF) cartilage damage grades >=3 in at least 2 of 10 subregions with absent or tiny osteophytes in all TF subregions. Progression of JSN and cartilage loss on MRI, was defined as (1) no, (2) slow, and (3) fast progression. Co-variance and logistic regression with generalized estimated equations were performed to assess the association of atrophic knee OA with any progression, compared to non-atrophic OA knees.A total of 476 knees from 432 participants were included. There were 50 (10.5%) knees with atrophic OA using the radiographic definition, and 16 (3.4%) knees with atrophic OA using MRI definition. Non-atrophic OA knees more commonly exhibited fast progression of JSN and cartilage damage. Logistic regression showed that the atrophic phenotype of knee OA was associated with a decreased likelihood of progression of JSN and cartilage loss.In this sample, the atrophic phenotype of knee OA was associated with a decreased likelihood of progression of JSN and cartilage loss compared to the non-atrophic knee OA phenotype.
EVALuna2:14704

Iterative Metal Artifact Reduction in Head and Neck CT Facilitates Tumor Visualization of Oral and Oropharyngeal Cancer Obscured by Artifacts From Dental Hardware - Bayerl, Nadine; May, Matthias; Wuest, Wolfgang; Roth, Jessica; Kramer, Manuel; Hofmann, Christian; Schmidt, Bernhard; Uder, Michael; Ellmann, Stephan (Academic Radiology, 2023)
Rationale and Objectives: The purpose of this study was to evaluate the diagnostic utility of iterative metal artifact reduction (iMAR) in computed tomography (CT)-imaging of oral and oropharyngeal cancers when obscured by dental hardware artifacts and to determine the most appropriate iMAR settings for this purpose. Materials and Methods: The study retrospectively enrolled 27 patients (8 female, 19 male; mean age 64 ± 12.7 years) with histologically confirmed oral or oropharyngeal cancer obscured by dental artifacts in contrast-enhanced CT. Raw CT data were reconstructed with ascending iMAR strengths (levels 1/2/3/4/5) and one reconstruction without iMAR (level 0). For subjective analysis, two blinded radiologists rated tumor visualization and artifact severity on a five-point Likert scale. For objective analysis, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and artifact index (AI) were determined. Results: iMAR reconstructions improved the subjective image quality of tumor edge and contrast, and the objective parameters of tumor SNR and CNR, reaching their optimum at iMAR levels 4 and 5 (P < .001). AI decreased with iMAR reconstructions reaching its minimum at iMAR level 5 (P < .001). Tumor detection rates increased 2.4-fold with iMAR 5, 2.1-fold with iMAR 4, and 1.9-fold with iMAR 3 compared to reconstructions without iMAR. Disadvantages such as algorithm-induced artifacts increased significantly with higher iMAR strengths (P < .05), reaching a maximum with iMAR 5. Conclusion: iMAR significantly improves CT imaging of oral and oropharyngeal cancers, as confirmed by both subjective and objective measures, with best results at highest iMAR strengths.
CRIS-Team Scopus Importer:2023-05-26
Keywords: Artifact; Cancer imaging; Computed tomography; Head and neck; Metal artifact reduction

Iterative reconstruction of radially-sampled (31)P bSSFP data using prior information from (1)H MRI - Rink, Kristian; Benkhedah, Nadia; Berger, Moritz C.; Gnahm, Christine; Behl, Nicolas G. R.; Lommen, Jonathan M.; Stahl, Vanessa; Bachert, Peter; Ladd, Mark E.; Nagel, Armin Michael (Magnetic Resonance Imaging, 2017)
The purpose of this study is to improve direct phosphorus ((31)P) MR imaging. Therefore, 3D density-adapted radially-sampled balanced steady-state free precession (bSSFP) sequences were developed and an iterative approach exploiting additional anatomical information from hydrogen ((1)H) data was evaluated. Three healthy volunteers were examined at B0=7T in order to obtain the spatial distribution of the phosphocreatine (PCr) intensities in the human calf muscle with a nominal isotropic resolution of 10mm in an acquisition time of 10min. Three different bSSFP gradient schemes were investigated. The highest signal-to-noise ratio (SNR) was obtained for a scheme with two point-reflected density-adapted gradients. Furthermore, the conventional reconstruction based on a gridding algorithm was compared to an iterative method using an (1)H MRI constraint in terms of a segmented binary mask, which comprises prior knowledge. The parameters of the iterative approach were optimized and evaluated by simulations featuring (31)P MRI parameters. Thereby, partial volume effects as well as Gibbs ringing artifacts could be reduced. In conclusion, the iterative reconstruction of (31)P bSSFP data using an (1)H MRI constraint is appropriate for investigating regions where sharp tissue boundaries occur and leads to images that represent the real PCr distributions better than conventionally reconstructed images.
EVALuna2:14640

IV-Thrombolysis in Ischemic Stroke With Unknown Time of Onset—Safety and Outcomes in Posterior vs. Anterior Circulation Stroke - Macha, Kosmas; Hölter, Philip; Siedler, Gabriela; Wang, Ruihao; Knott, Michael; Stoll, Svenja; Engelhorn, Tobias; Dörfler, Arnd; Schwab, Stefan; Mühlen, Iris; Kallmünzer, Bernd (Frontiers in Neurology, 2021)
Background: rt-PA for ischemic stroke in the unknown or extended time window beyond the first 4. 5 h after symptom onset is safe and effective for certain patients after selection by multimodal neuroimaging. However, the evidence for this approach comes mainly from patients with anterior circulation stroke (ACS), while the data on posterior circulation stroke (PCS) are scarce. Methods: Ischemic stroke patients treated with IV-thrombolysis in the unknown or extended time window between January 2011 and May 2019 were identified from an institutional registry. The patients were categorized into PCS or ACS based on clinico-radiological findings. We analyzed the hemorrhagic complications, clinical and imaging efficacy outcomes, and mortality rates by comparing the PCS and ACS patient groups. Adjusted outcome analyses were performed after propensity score matching for the relevant factors. Results: Of the 182 patients included, 38 (20.9%) had PCS and 144 (79.1%) had ACS. Symptomatic acute large vessel occlusion (LVO) was present in 123 patients on admission [27 (22.0%) PCS and 96 (78.0%) ACS]. The score on the National Institutes of Health Stroke Scale (NIHSS), the time from last seen normal, and the door-to-needle times were similar in PCS and ACS. In patients with LVO, the NIHSS score was lower [8 (5–15) vs. 14 (9–18), p = 0.005], and infarction visible on follow-up imaging was less common [70.4 vs. 87.5%; aRD, −18.9% (−39.8 to −2.2%)] in the PCS patient group. There was a trend toward a lower risk for intracranial hemorrhage (ICH) following intravenous thrombolysis in PCS vs. ACS, without reaching a statistical significance [5.3 vs. 16.9%; aRD, −10.4% (−20.4 to 4.0%)]. The incidence of symptomatic ICH [according to the ECASS III criteria: 2.6 vs. 3.5%; aRD, −2.9% (−10.3 to 9.2%)], efficacy outcomes, and mortality rates were similar in PCS and ACS patients. Conclusions: In this real-world clinical cohort, the safety and the efficacy of rt-PA for ischemic stroke in the unknown or extended time window did not show relevant differences between PCS and ACS, with a trend toward less hemorrhagic complications in PCS. The findings reconfirm the clinician in the usage of rt-PA beyond the first 4.5 h also in selected patients with PCS.
CRIS-Team Scopus Importer:2021-10-01
Keywords: anterior circulation stroke; extended time window; IV-thrombolysis; posterior circulation stroke; wake-up stroke

Janus-faced spatacsin (SPG11): involvement in neurodevelopment and multisystem neurodegeneration - Pozner, Tatyana; Regensburger, Martin; Engelhorn, Tobias; Winkler, Jürgen; Winner, Beate (Brain, 2020)
Hereditary spastic paraplegia (HSP) is a heterogeneous group of rare motor neuron disorders characterized by progressive weakness and spasticity of the lower limbs. HSP type 11 (SPG11-HSP) is linked to pathogenic variants in the SPG11 gene and it represents the most frequent form of complex autosomal recessive HSP. The majority of SPG11-HSP patients exhibit additional neurological symptoms such as cognitive decline, thin corpus callosum, and peripheral neuropathy. Yet, the mechanisms of SPG11-linked spectrum diseases are largely unknown. Recent findings indicate that spatacsin, the 280 kDa protein encoded by SPG11, may impact the autophagy-lysosomal machinery. In this update, we summarize the current knowledge of SPG11-HSP. In addition to clinical symptoms and differential diagnosis, our work aims to link the different clinical manifestations with the respective structural abnormalities and cellular in vitro phenotypes. Moreover, we describe the impact of localization and function of spatacsin in different neuronal systems. Ultimately, we propose a model in which spatacsin bridges between neurodevelopmental and neurodegenerative phenotypes of SPG11-linked disorders.
CRIS-Team Scopus Importer:2020-09-04
Keywords: autophagy; hereditary spastic paraplegia; neurodegeneration; neurodevelopment; SPG11

Klinische und echographische Untersuchungsbefunde bei Patienten mit Carotis-Sinus-cavernosus-Fisteln - Huebner, L.; Struffert, T.; Mardin, Christian; Engelhorn, Tobias; Holbach, L.; Weller, J.; Hohberger, Bettina; Gusek-Schneider, Gabriele (Ophthalmologe, 2021)
Background: Symptoms and clinical findings in patients with carotid-cavernous fistulas are specific. Nevertheless, they can be very mildly expressed. This study aims to point out the potential diagnostic value of ultrasound of the orbit. Methods: A total of 25 patients with a reliable angiographic diagnosis of a fistula were reviewed retrospectively. We analyzed the symptoms, clinical findings and demonstrability in ultrasound of the orbit. Results: The most common clinical findings were nerve palsy, dilation of episcleral vessels and exophthalmos. If an ultrasound had been part of the examination a dilation of the superior ophthalmic vein could be demonstrated in all cases. Conclusion: The expeditious ultrasound investigation provides valuable information for the diagnosis of red eyes which are resistant to treatment. The examiner has to consider a fistula and perform an ultrasound especially when diplopia has newly occurred. Finally, the expedient neuroimaging can be arranged.
CRIS-Team Scopus Importer:2021-02-05
Keywords: Diplopia; Echography; Exophthalmos; Red eye; Superior ophthalmic vein

Knee cartilage damage and concomitant internal derangement on MRI in athletes competing at the Rio de Janeiro 2016 Summer Olympics - Ahmad, Zohaib; Murakami, Akira M.; Engebretsen, Lars; Jarraya, Mohamed; Roemer, Frank; Guermazi, Ali; Kompel, Andrew J. (European Journal of Radiology, 2020)
Purpose: To report the MRI patterns of knee cartilage damage and concomitant internal derangement in athletes participating at the Rio de Janeiro 2016 Olympic Games. Methods: Knee MRIs obtained at the core imaging facility of the International Olympic Committee were blindly, retrospectively reviewed by a board-certified musculoskeletal radiologist for meniscal, ligamentous, and tendon abnormalities. Cartilage assessment was based on the modified Outerbridge criteria. Results: Of 122 athletes who received a knee MRI, 64 (52.4 %) had cartilage damage. Cartilage damage was more prevalent in the patellofemoral compartment (52 athletes, 42.6 %), followed by lateral (23 athletes, 18.9 %) and medial tibiofemoral compartments (12 athletes, 9.8 %). Patellofemoral cartilage damage was most prevalent in beach-volleyball (100 %), followed by volleyball (8 athletes, 66.7 %) and weightlifting (7 athletes, 70 %). Patellofemoral cartilage damage was most prevalent with quadriceps (8 athletes, 72.7 %) and patellar tendinosis (11 athletes, 61.1 %). Medial and lateral tibiofemoral cartilage damage was significantly associated with medial (8 athletes, 29.6 %) and lateral meniscal tears (16 athletes, 55.2 %), respectively. There was a trend for the percentage of athletes with cartilage damage to increase with age. Conclusion: The majority of athletes at the 2016 Rio Summer Olympics who had a knee MRI showed cartilage damage. Patellofemoral compartment cartilage damage was most common and frequently observed in certain sports including volleyball, beach volleyball, and weightlifting. Overuse in these sports can contribute to patellofemoral cartilage damage and subsequent development of anterior knee pain. Cartilage damage was also observed with concomitant meniscal tears and older age.
CRIS-Team Scopus Importer:2020-09-25
Keywords: Cartilage; Knee; MRI; Olympics; Rio

Knee joint subchondral bone structure alterations in active athletes: a cross-sectional case-control study - Roemer, Frank; Jarraya, M.; Niu, J.; Duryea, J.; Lynch, J. A.; Guermazi, Ali (Osteoarthritis and Cartilage, 2015)
It has been shown that trabecular bone structure parameters extracted from radiographs known as fractal signature analysis (FSA) are able to predict structural outcomes such as radiographic osteoarthritis (OA) progression. Little is known about their involvement in early disease or about differences between subjects exposed to increased joint loading such as young active athletes compared to non-athletes. Aim was to compare horizontal and vertical dimensions of bone texture considering athlete status, gender, previous anterior cruciate ligament (ACL) surgery and age.Included were 685 patients of which 135 consecutive athletes (82% soccer players) 18-36 years old and 550 non-athletes controls in the same age range had knee radiography for assessment of subacute or chronic knee complaints. Regions of interest (ROI) were placed in the subchondral medial and lateral tibial plateaus. Fractal signatures were calculated in the horizontal and vertical dimensions. Curve fitting algorithms were applied taking into account all four risk factors in the same model adjusting for each other.For the horizontal dimensions significant differences were observed for gender (estimate (E) 0.098 (95% confidence interval(CI)) (-0.009, 0.008), P < .0001), previous ACL surgery (E -0.031, 95% CI (-0.043, -0.019), P < .0001) and highest age group (E -0.039, 95% CI (-0.048, -0.029), P < .0001). For vertical dimensions, significant differences were shown for athletes (E -0.012, 95% CI (-0.020, -0.004), P < .0001), gender (E 0.056, 95% CI (0.049, 0.062), P < .0001), and age range from 28 to 32 years (E -0.028, 95% CI (-0.037, -0.019), P < .0001).Trabecular bone structure differs between athletes and non-athletes, in regard to previous ACL surgery, gender and higher age.
EVALuna2:14532

Kneeling as a risk factor of patellofemoral joint cartilage damage worsening: an exploratory analysis on the Osteoarthritis Initiative - Haj-Mirzaian, Arya; Mohajer, Bahram; Guermazi, Ali; Roemer, Frank; Zikria, Bashir; Demehri, Shadpour (European Radiology, 2020)
Objectives: To determine whether kneeling activity is associated with the MRI measures of patellofemoral (PF) joint cartilage damage worsening in subjects with/without patella alta (PA). Methods: Baseline and 24-month 3-T MR images and semi-quantitative MRI Osteoarthritis Knee Score (MOAKS) of PF joint of 600 subjects from the FNIH study, a nested study within the Osteoarthritis Initiative (OAI), were extracted. At baseline visit, subjects were asked how many days per week they participated in kneeling activities lasted ≥ 30 min. Insall-Salvati ratio (ISR) (patellar tendon/patellar height) was measured on baseline MRIs by a musculoskeletal radiologist; ISR ≥ 1.3 was considered PA. Regression analysis adjusted for confounding variables was used to assess the impact of kneeling on worsening of MOAKS cartilage over 24 months. The potential moderating effect of PA was evaluated using adjusted regression analysis. Results: Six hundred subjects (58.8% female, years, BMI = 30.7 ± 4.8 kg/m2) were included; 13.7%, 6.2%, and 5.5% of participants reported 1 day, 2–5 days, and ≥ 6 days of kneeling activities per week. A higher frequency of kneeling activity was associated with the increased risk of MOAKS cartilage score worsening (adjusted OR (95% CI): 2.33 (1.08–5.06)). Stratification analysis showed that only ≥ 6 days/week of kneeling activities was associated with the worsening of MOAKS cartilage scores (2.74 (1.03–7.27)). When we included the presence of PA in regression models, the OR (95% CI) for the association between kneeling and PF cartilage damage will decrease to 1.26 (0.78–2.04), suggesting the potential role of PA as the moderator variable. Conclusion: Extensive kneeling activity (≥ 6 days/week) may be associated with the MRI-based worsening of PF cartilage damage, specifically in subjects with an underlying patella alta. Key Points: • Frequent daily kneeling activity is associated with a higher risk of patellofemoral cartilage damage resulting in patellofemoral osteoarthritis. • The cartilage damage associated with extensive kneeling activity may be worse in subjects with an underlying patella alta (i.e., high-riding patella).
CRIS-Team Scopus Importer:2020-10-09
Keywords: Cartilage; Magnetic resonance imaging; Osteoarthritis; Patellofemoral joint

KNEES WITH DISTINCT STRUCTURAL PHENOTYPES ARE AT INCREASED RISK FOR PROGRESSION: A SECONDARY ANALYSIS FROM THE FNIH COHORT - Roemer, Frank; Collins, J. C.; Neogi, T.; Crema, M. D.; Guermazi, A. (OSTEOARTHRITIS AND CARTILAGE, 2020)
CRIS-Team WoS Importer:2020-06-02

Knee tissue lesions and prediction of incident knee osteoarthritis over 7 years in a cohort of persons at higher risk - Sharma, Leena; Hochberg, M.; Nevitt, M.; Guermazi, Ali; Roemer, Frank; Crema, M. D.; Eaton, C.; Jackson, R.; Kwoh, K.; Cauley, Jane A; Almagor, O.; Chmiel, J. S. (Osteoarthritis and Cartilage, 2017)
OBJECTIVE: Among high risk individuals, whether knee lesions in tissues involved in osteoarthritis (OA) can improve prediction of knee OA is unclear. We hypothesized that models predicting (1) incident osteophytes and (2) incident osteophytes and joint space narrowing can be improved by including symptoms or function, and further improved by lesion status. DESIGN: In Osteoarthritis Initiative (OAI) participants with normal knee X-rays, we assessed cartilage damage, bone marrow lesions (BMLs), and menisci. Cox proportional hazards models were used to develop risk prediction models for risk of each outcome. Nested models (increasingly larger baseline covariable sets) were compared using likelihood ratio tests and Schwarz Bayesian Information Criterion (SBC). Model discrimination used receiver operating characteristic (ROC) curves and area under the curve (AUC). RESULTS: In 841 participants [age 59.6, body mass index (BMI) 26.7, 55.9% women] over up to 7 years follow-up, each larger set improved prediction (+hand OA, injury, surgery, activities; +symptoms/function). Prediction was further improved by including cartilage damage both compartments, BMLs both compartments, meniscal tear, meniscal extrusion, sum of lesion types, number of subregions with cartilage damage, number of subregions with BMLs, and (concurrently) subregion number with cartilage damage, subregion number with BMLs, and meniscal tear. AUCs were ≥0.80 for both outcomes for number of subregions with cartilage damage and the combined model. CONCLUSIONS: Among persons at higher risk for knee OA with normal X-rays, MRI tissue lesions improved prediction of mild as well as moderate disease. These findings support that disease onset is likely occurring during the "high-risk" period and encourage a reorientation of approach.
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Kommentar zu „MSK - Diffusions-Mikrostrukturbildgebung der Schulter - Janka, Rolf Matthias (Röfo: Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2023)
CRIS-Team Scopus Importer:2023-11-24

Kontrastmittelfreie Mamma-MRT: Vorteile und potenzielle Nachteile - Baltzer, P. A.T.; Kapetas, P.; Sodano, C.; Dietzel, Matthias; Pinker, K.; Helbich, T. H.; Clauser, P. (Radiologe, 2019)
Background: Contrast-enhanced breast magnetic resonance imaging (MRI) is the most sensitive method for detection of breast cancer. The further spread of breast MRI is limited by the complicated examination procedure and the need for intravenously administered contrast media. Objectives: Can diffusion-weighted imaging (DWI) replace contrast-enhanced sequences to achieve an unenhanced breast MRI examination? Materials and methods: Narrative review and meta-analytic assessment of previously published studies. Results: DWI can visualize breast lesions and distinguish benign from malignant findings. It is thus a valid alternative to contrast-enhanced sequences. As an additional technique, the use of DWI can reduce the numbers of unnecessary breast biopsies. The lack of robustness leading to variable sensitivity that is currently lower than that of contrast-enhanced breast MRI is a disadvantage of DWI. Conclusions: Presently, DWI can be recommended as an integral part of clinical breast MRI protocols. The application as a stand-alone technique within unenhanced protocols is still under evaluation.
CRIS-Team Scopus Importer:2019-05-02
Keywords: Breast cancer; Diffusion-weighted imaging; Magnetic resonance imaging; Screening; Sensitivity

Laboratory diagnosis of congenital CMV infection in newborns: Impact of pre-analytic factors - Kohmer, N.; Nagel, Armin Michael; Berger, A.; Enders, M.; Hamprecht, K.; Korn, Klaus; Kortenbusch, M.; Überla, Klaus; Rabenau, H. F. (Journal of Clinical Virology, 2019)
Background: To identify infants with congenital cytomegalovirus (cCMV) saliva polymerase chain reaction (PCR) is an ideal screening method. However, there are only few data on the influence of pre-analytic factors on the analytical sensitivity of the CMV PCR. Objectives: This study aimed to evaluate the performance of different swabbing materials, transport time and initial virus concentration regarding to the efficacy of recovery of CMV-DNA. Study design: Two CMV suspensions containing a high or low concentration of the laboratory strain AD 169 were prepared as test samples. Sampling was simulated by immersion of different swabs in these CMV suspensions and storing the swabs dry or in specified transport media. Transport conditions were modeled by storing the samples for defined time periods prior to DNA extraction and quantitative PCR analyses. Parallel analyses in two different laboratories allowed determination of lab to lab consistency. Results: The duration of storage under the conditions analysed did not have a major effect on the recovery efficiency for the swabbing materials tested. With exception of flocked dry swabs, all tested swabbing materials demonstrated good recovery of CMV DNA. The flocked swab/eNAT system showed the best overall performance. Conclusions: All tested swabbing materials (with exception of the flocked dry swabs) seem to be well suited for recovery of CMV DNA and appropriate for use for the diagnosis of cCMV infection in symptomatic cases and in general cCMV screening programs of newborns.
CRIS-Team Scopus Importer:2019-05-02
Keywords: CMV; Congenital; Cytomegalovirus; PCR; Screening; Swabs

Lateral patellar tilt and its longitudinal association with patellofemoral osteoarthritis-related structural damage: Analysis of the osteoarthritis initiative data - Zikria, Bashir; Rinaldi, Joseph; Guermazi, Ali; Haj-Mirzaian, Arya; Pishgar, Farhad; Roemer, Frank; Hakky, Michael; Sereni, Christopher; Demehri, Shadpour (Knee, 2020)
Background: Increase in lateral patellar tilt-(LPT) can cause increased pressure on the lateral facet of the knee and can lead to patellar or femoral cartilage damage and further osseous changes. This study aims to test the hypothesis whether there is an association between increased LPT and MRI-based patellofemoral osteoarthritis-(OA) features at baseline and their worsening over a 2-year follow-up in participants of the Osteoarthritis Initiative-(OAI). Methods: Recorded clinical and imaging data of 600 participants in the FNIH-OA biomarkers consortium was extracted from its database. The LPT-(as the angle between the longest patella diameter and posterior aspect of condyles) was measured using the axial knee MRI. Associations of LPT (every 5° increase) with MRI OA Knee Scoring-(MOAKS) for OA-related features, including cartilage and bone marrow lesions (BMLs) in addition to knee cartilage volume at baseline and their worsening after 2-year follow-up were assessed using regression models adjusted for several possible confounders. Results: The mean LPT angle in this sample was 8.84° ± 5.19. In baseline, higher LPT was associated with lower cartilage volumes and higher cartilage lesions and BMLs MOAKS scores in the lateral trochlear and patellar subregions. Over the follow-ups, subjects with higher LPT measures in the baseline showed higher odds of experiencing BML score worsening in the lateral trochlear subregion-(OR:1.25[1.01–1.56]) over the 2-year follow-ups. Conclusions: Increase in LPT measures may be associated with OA-related features in the trochlear subregion. Therefore, aside from its use as an indicator of patellofemoral instability syndrome, LPT may be associated with longitudinal progression of patellofemoral OA.
CRIS-Team Scopus Importer:2020-12-04
Keywords: Lateral patella tilt; Magnetic resonance imaging; Osteoarthritis; Patellofemoral

Latest advancements in imaging techniques in OA - Hayashi, Daichi; Roemer, Frank; Link, Thomas; Li, Xiaojuan; Kogan, Feliks; Segal, Neil A. A.; Omoumi, Patrick; Guermazi, Ali (Therapeutic Advances in Musculoskeletal Disease, 2022)
The osteoarthritis (OA) research community has been advocating a shift from radiography-based screening criteria and outcome measures in OA clinical trials to a magnetic resonance imaging (MRI)-based definition of eligibility and endpoint. For conventional morphological MRI, various semiquantitative evaluation tools are available. We have lately witnessed a remarkable technological advance in MRI techniques, including compositional/physiologic imaging and automated quantitative analyses of articular and periarticular structures. More recently, additional technologies were introduced, including positron emission tomography (PET)-MRI, weight-bearing computed tomography (CT), photon-counting spectral CT, shear wave elastography, contrast-enhanced ultrasound, multiscale X-ray phase contrast imaging, and spectroscopic photoacoustic imaging of cartilage. On top of these, we now live in an era in which artificial intelligence is increasingly utilized in medicine. Osteoarthritis imaging is no exception. Successful implementation of artificial intelligence (AI) will hopefully improve the workflow of radiologists, as well as the level of precision and reproducibility in the interpretation of images.
CRIS-Team WoS Importer:2023-03-03

Layer-specific femorotibial cartilage T2 relaxation time in knees with and without early knee osteoarthritis: Data from the Osteoarthritis Initiative (OAI) - Wirth, W.; Maschek, S.; Roemer, Frank; Eckstein, F. (Scientific Reports, 2016)
Magnetic resonance imaging (MRI)-based spin-spin relaxation time (T2) mapping has been shown to be associated with cartilage matrix composition (hydration, collagen content &orientation). To determine the impact of early radiographic knee osteoarthritis (ROA) and ROA risk factors on femorotibial cartilage composition, we studied baseline values and one-year change in superficial and deep cartilage T2 layers in 60 subjects (age 60.6 ± 9.6 y; BMI 27.8 ± 4.8) with definite osteophytes in one knee (earlyROA, n = 32) and with ROA risk factors in the contralateral knee (riskROA, n = 28), and 89 healthy subjects (age 55.0 ± 7.5 y; BMI 24.4 ± 3.1) without signs or risk factors of ROA. Baseline T2 did not differ significantly between earlyROA and riskROA knees in the superficial (48.0 ± 3.5 ms vs. 48.1 ± 3.1 ms) or the deep layer (37.3 ± 2.5 ms vs. 37.3 ± 1.8 ms). However, healthy knees showed significantly lower superficial layer T2 (45.4 ± 2.3 ms) than earlyROA or riskROA knees (p <= 0.001) and significantly lower deep layer T2 (35.8 ± 1.8 ms) than riskROA knees (p = 0.006). Significant longitudinal change in T2 (superficial: 0.5 ± 1.4 ms; deep: 0.8 ± 1.3 ms) was only detected in healthy knees. These results do not suggest an association of early ROA (osteophytes) with cartilage composition, as assessed by T2 mapping, whereas cartilage composition was observed to differ between knees with and without ROA risk factors.
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Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study - Adeeb, N.; Dibas, Mahmoud; Griessenauer, C. J.; Cuellar, H. H.; Salem, M. M.; Xiang, S.; Enriquez-Marulanda, A.; Hong, T.; Zhang, H.; Taussky, P.; Grandhi, R.; Waqas, M.; et al. (American Journal of Neuroradiology, 2022)
BACKGROUND AND PURPOSE: Flow diversion has gradually become a standard treatment for intracranial aneurysms of the anterior circulation. Recently, the off-label use of the flow diverters to treat posterior circulation aneurysms has also increased despite initial concerns of rupture and the suboptimal results. This study aimed to explore the change in complication rates and treatment outcomes across time for posterior circulation aneurysms treated using flow diversion and to further evaluate the mechanisms and variables that could potentially explain the change and outcomes. MATERIALS AND METHODS: A retrospective review using a standardized data set at multiple international academic institutions was performed to identify patients with ruptured and unruptured posterior circulation aneurysms treated with flow diversion during a decade spanning January 2011 to January 2020. This period was then categorized into 4 intervals. RESULTS: A total of 378 procedures were performed during the study period. Across time, there was an increasing tendency to treat more vertebral artery and fewer large vertebrobasilar aneurysms (P = .05). Moreover, interventionalists have been increasingly using fewer overlapping flow diverters per aneurysm (P = .07). There was a trend toward a decrease in the rate of thromboembolic complications from 15.8% in 2011?13 to 8.9% in 2018?19 (P = .34).CONCLUSIONS: This multicenter experience revealed a trend toward treating fewer basilar aneurysms, smaller aneurysms, and increased usage of a single flow diverter, leading to a decrease in the rate of thromboembolic and hemorrhagic complications.
CRIS-Team WoS Importer:2022-10-28

Left Ventricular Structure in Patients With Mild-to-Moderate CKD-a Magnetic Resonance Imaging Study - Schneider, Markus; Scheppach, Johannes B.; Raff, Ulrike; Toncar, Sebastian; Ritter, Christian; Klink, Thorsten; Stoerk, Stefan; Wanner, Christoph; Schlieper, Georg; Saritas, Turgay; Reinartz, Sebastian D.; Floege, Juergen; et al. (Kidney International Reports, 2019)
Introduction: The high burden of left ventricular (LV) abnormalities in patients with advanced chronic kidney disease (CKD) is well established. However, less is known about the prevalence, patterns, and determinants of LV abnormalities in patients with early CKD.
CRIS-Team WoS Importer:2019-02-21

Lesion correlates of secondary paroxysmal dyskinesia in multiple sclerosis - Fröhlich, Katharina; Winder, Klemens; Linker, Ralf; Huhn, Konstantin; Engelhorn, Tobias; Dörfler, Arnd; Lee, De-Hyung; Schwab, Stefan; Seifert, Frank (Journal of Neurology, 2018)
Secondary paroxysmal dyskinesia is a rare but life-quality-compromising symptom in multiple sclerosis (MS) and might be associated with particular MS lesions. The present study intended to determine associations between paroxysmal dyskinesia and the MS-associated lesion site using a voxelwise lesion analysis. We conducted a retrospective study and sought MS patients with documented paroxysmal dyskinesia and controls without paroxysmal dyskinesia matched for age, disease severity, and disease duration in a local database. The MS lesions were analysed on T2-weighted magnetic resonance imaging scans (1.5 or 3 T), manually outlined, and transformed into stereotaxic space. We determined the lesion overlap and compared the absence or presence of paroxysmal dyskinesia voxelwise between patients with and without lesions in a given voxel using the Liebermeister test with 4000 permutations. From 15,869 MS patient records screened, we identified 25 patients with paroxysmal dyskinesia. The voxelwise analysis in 22 subjects yielded associations between paroxysmal dyskinesia and MS lesions in the internal capsule, the basal ganglia, and another prominent lesion cluster in the posterior periventricular white matter. Our voxelwise analysis shows associations between paroxysmal dyskinesia and MS lesions in the internal capsule and basal ganglia, areas contributing to motor sequence programming. This association in another lesion site located in the posterior thalamic radiation suggests that lesions in subcortical sensory pathways may also contribute to paroxysmal dyskinesia in MS.
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Lesion mapping of stroke-related erectile dysfunction - Winder, Klemens; Seifert, Frank; Köhrmann, Martin; Crodel, Carl; Kloska, Stephan; Dörfler, Arnd; Hoesl, Katharina M.; Schwab, Stefan; Hilz, Max-Josef (Brain, 2017)
Acute ischaemic stroke in brain areas contributing to male sexual function may impair erectile function depending on the lesion site. This study intended to determine associations between stroke-related erectile dysfunction and cerebral ischaemic lesion sites using voxel-based lesion mapping. In 52 males (mean age 60.5 ± 10.5 years) with first-ever ischaemic strokes, we assessed erectile function after and retrospectively 3 months prior to the stroke using scores of the 5-item International Index of Erectile Function-5 questionnaire. We assessed cardiovascular risk factors and determined clinical stroke severity and infarct volumes as well as total brain volume by neuroimaging. We calculated correlations between patient age, clinical stroke severity, infarct volumes as well as brain volumes and the difference between erectile dysfunction scores before and after stroke. Moreover, we compared patient age, prevalence of cardiovascular risk factors, clinical stroke severity, infarct volumes and brain volumes of patients with unchanged and deteriorated erectile function after stroke. The infarcts were manually outlined and transformed into stereotaxic space. We determined the lesion overlap and performed subtraction analyses of lesions. In a voxel-based lesion analysis, the difference between erectile dysfunction scores before and after stroke was correlated with the lesion site using t-test statistics. Finally, we conducted a region of interest-based multivariate linear regression analysis that was adjusted for potential confounding factors including patient age, clinical stroke severity, imaging modality, lesion size and brain volume. In 32 patients (61.5%) erectile dysfunction scores declined after the stroke and therefore had stroke-related erectile dysfunction. Deterioration of erectile dysfunction scores was not associated with patient age, clinical stroke severity, infarct volume, brain volume, and cardiovascular risk factors. The voxel-wise subtraction analysis showed associations between stroke-related erectile dysfunction and lesion sites in the right occipito-parietal cortex and thalamus, as well as in the left insula and adjacent temporo-parietal areas. Using voxel-wise t-test statistics, we showed associations between deterioration of erectile function and lesion sites in the right occipital and thalamic region, and the left parietal association area. The linear regression analysis showed that stroke-related erectile dysfunction remained associated with lesions of the right occipital and left parietal association areas after adjusting for confounding factors. In conclusion, our voxel-wise analysis indicates that deteriorating erectile function after stroke is associated with lesions in the right occipito-parietal and thalamic areas integrating visual and somatosensory information, as well as lesions in the left insular and adjacent parieto-temporal areas contributing to generating and mapping visceral arousal states.
EVALuna2:22497

Lesion type and reader experience affect the diagnostic accuracy of breast MRI: a multiple reader ROC study - Baltzer, Pascal A. T.; Kaiser, Werner Alois; Dietzel, Matthias (European Journal of Radiology, 2015)
To evaluate the influence of lesion type (mass versus non-mass) and reader experience on the diagnostic performance of breast MRI (BMRI) in a non-screening setting.Consecutive patients (mean age, 55 ± 12 years) with breast lesions that were verified by biopsy or surgery, and who had had BMRI as part of their diagnostic workup, were eligible for this retrospective single-center study. Cancers diagnosed by biopsy before BMRI were excluded to eliminate biological and interpretation bias due to biopsy or chemotherapy effects (n=103). Six blinded readers (experience level, high (HE, n=2); intermediate (IE, n=2); and low (LE, n=2)) evaluated all examinations and assigned independent MRI BI-RADS ratings. Lesion type (mass, non-mass, focal) was noted. Receiver operating characteristics (ROC) and logistic regression analysis was performed to compare diagnostic accuracies.There were 259 histologically verified lesions (123 malignant, 136 benign) investigated. There were 169 mass (103 malignant, 66 benign) and 48 non-mass lesions (19 malignant, 29 benign). Another 42 lesions that met the inclusion criteria were biopsied due to conventional findings (i.e., microcalcifications, architectural distortions), but did not enhance on MRI (41 benign, one DCIS). ROC analysis revealed a total area under the curve (AUC) between 0.834 (LE) and 0.935 (HI). Logistic regression identified a significant effect of non-mass lesions (P<0.0001) and reader experience (P=0.005) on diagnostic performance.Non-mass lesion type and low reader experience negatively affect the diagnostic performance of breast MRI in a non-screening setting.
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Li-Fraumeni syndrome - Keymling, Myriam; Schlemmer, Heinz-Peter; Kratz, Christian; Pfeil, Alexander; Bickelhaupt, Sebastian; Alsady, Tawfik Moher; Renz, Diane Miriam (Die Radiologie, 2022)
Background The autosomal dominant inherited Li-Fraumeni syndrome (LFS) increases the lifetime risk of developing a malignancy to almost 100%. Although breast cancer, central nervous system (CNS) tumors and sarcomas are particularly common, tumors can ultimately occur almost anywhere in the body. As causal therapy is not available, the primary focus for improving the prognosis is early cancer detection. To this end, current cancer surveillance recommendations include a series of examinations including regular imaging beginning at birth. Challenges in imaging in LFS Due to the wide range of tumor entities that can occur in individuals affected by LFS, a sensitive detection requires imaging of various tissue contrasts; however, because life-long screening is potentially initiated at a young age, this requirement for comprehensiveness must be balanced against the presumed high psychological burden associated with frequent or invasive examinations. As radiation exposure may lead to an increased (secondary) tumor risk, computed tomography (CT) and X-ray examinations should be avoided as far as possible. Current status and perspectives Because annual whole-body magnetic resonance imaging (MRI) has no radiation exposure and yet a high sensitivity for many tumors, it forms the basis of the recommended imaging; however, due to the rarity of the syndrome, expertise is sometimes lacking and whole-body MRI examinations are performed heterogeneously and sometimes with limited diagnostic quality. Optimization and standardization of MRI protocols should therefore be pursued. In addition, the need for an intravenously administered contrast agent has not been conclusively clarified despite its high relevance.
CRIS-Team WoS Importer:2022-10-07

Ligamentous Injuries and the Risk of Associated Tissue Damage in Acute Ankle Sprains in Athletes: A Cross-sectional MRI Study - Roemer, Frank; Jomaah, Nabil; Niu, Jingbo; Almusa, Emad; Roger, Bernard; D'Hooghe, Pieter; Geertsema, Celeste; Tol, Johannes L.; Khan, Karim; Guermazi, Ali (American Journal of Sports Medicine, 2014)
Ankle joint injuries are extremely common sports injuries, with the anterior talofibular ligament involved in the majority of ankle sprains. There have been only a few large magnetic resonance imaging (MRI) studies on associated structural injuries after ankle sprains.To describe the injury pattern in athletes who were referred to MRI for the assessment of an acute ankle sprain and to assess the risk of associated traumatic tissue damage including lateral and syndesmotic ligament involvement.Cross-sectional study; Level of evidence, 3.A total of 261 ankle MRI scans of athletes with acute ankle sprains were evaluated for: lateral and syndesmotic ligament injury; concomitant injuries to the deltoid and spring ligaments and sinus tarsi; peroneal, flexor, and extensor retinacula and tendons; traumatic and nontraumatic osteochondral and osseous changes; and joint effusion. Patients were on average 22.5 years old, and the average time from injury to MRI was 5.7 days. Six exclusive injury patterns were defined based on lateral and syndesmotic ligament involvement. The risk for associated injuries was assessed by logistic regression using ankles with no or only low-grade lateral ligament injuries and no syndesmotic ligament damage as the reference.With regard to the injury pattern, there were 103 ankles (39.5%) with complete anterior talofibular ligament disruption and no syndesmotic injury, and 53 ankles (20.3%) had a syndesmotic injury with or without lateral ligament damage. Acute osteochondral lesions of the lateral talar dome were seen in 20 ankles (7.7%). The percentage of chronic lateral osteochondral lesions was 1.1%. The risk for talar bone contusions increased more than 3-fold for ankles with complete lateral ligament ruptures (adjusted odds ratio [aOR], 3.43; 95% CI, 1.72-6.85) but not for ankles with syndesmotic involvement. The risk for associated deltoid ligament injuries increased for ankles with complete lateral ligament injuries (aOR, 4.04; 95% CI, 1.99-8.22) compared with patients with no or only low-grade lateral ligament injuries.About 20% of athletes referred for MRI after suffering an acute ankle sprain had evidence of a syndesmotic injury regardless of lateral ligament involvement, while more than half had evidence of any lateral ligament injury without syndesmotic involvement. Concomitant talar osseous and deltoid ligament injuries are common.
EVALuna2:14354

Limited versus Whole-Brain Perfusion for the Indication of Thrombolysis in the Extended Time Window of Acute Cerebral Ischemia - Breuer, Lorenz; Knott, Michael; Struffert, Tobias; Kloska, Stephan; Kurka, Natalia; Schwab, Stefan; Dörfler, Arnd; Köhrmann, Martin; Engelhorn, Tobias (Journal of Stroke and Cerebrovascular Diseases, 2015)
Perfusion computed tomography (PCT) has emerged as alternative to magnetic resonance imaging (MRI) for assessment of patients clinically qualifying for off-label thrombolysis within 4.5 to 9 hours after onset of ischemic stroke. However, disadvantage of PCT is its often limited anatomic coverage with only 2 or 3 slices when using a 4- to 64-section scanner. Our purpose was therefore to evaluate the value of 2- and 3-slice perfusion compared to whole-brain perfusion.One hundred twenty-five patients undergoing MRI beyond 4.5 hours after symptom onset with supratentorial perfusion deficit were selected retrospectively. Accordingly to PCT slice positioning, 2 or 3 slices of the whole-brain perfusion weighted imaging data set were depicted. Volumes of infarct (using cerebral blood volume) and penumbra (using time-to-peak and cerebral blood volume) were calculated, and results were compared with 2- and 3-slice-derived volumes, respectively.Whole-brain imaging revealed a mismatch of more than 20% in 68.8% of patients (defined as 100%). Two-slice imaging detected a perfusion deficit in 72% and a mismatch in 48.8% (sensitivity = 70.9%). Three-slice imaging detected a perfusion deficit in 76% and a mismatch in 50.4% (sensitivity = 73.3%). Although there was no significant difference between 2- and 3-slice imaging (P > .23), both techniques revealed significantly less patients with mismatch compared to whole-brain coverage (P < .01).Two- and 3-slice imaging like obtained with PCT on most installed CT systems to assess perfusion deficits with subsequent mismatch calculation in acute stroke outside the 4.5-hour time window is significantly inferior to whole-brain coverage and, hence, has to be considered as a less-than-ideal solution.
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Limits of the possible: diagnostic image quality in coronary angiography with third-generation dual-source CT - Ochs, Marco M.; Siepen, Fabian Aus Dem; Fritz, Thomas; Andre, Florian; Gitsioudis, Gitsios; Korosoglou, Grigorios; Seitz, Sebastian; Bogomazov, Yuriy; Schlett, Christopher L.; Sokiranski, Roman; Sommer, Andre; Gueckel, Friedemann; et al. (Clinical Research in Cardiology, 2017)
BACKGROUND: The usage of coronary CT angiography (CTA) is appropriate in patients with acute or chronic chest pain; however the diagnostic accuracy may be challenged with increased Agatston score (AS), increased heart rate, arrhythmia and severe obesity. Thus, we aim to determine the potential of the recently introduced third-generation dual-source CT (DSCT) for CTA in a 'real-life' clinical setting. METHODS: Two hundred and sixty-eight consecutive patients (age: 67 ± 10 years; BMI: 27 ± 5 kg/m²; 61% male) undergoing clinically indicated CTA with DSCT were included in the retrospective single-center analysis. A contrast-enhanced volume dataset was acquired in sequential (SSM) (n = 151) or helical scan mode (HSM) (n = 117). Coronary segments were classified in diagnostic or non-diagnostic image quality. A subset underwent invasive angiography to determine the diagnostic accuracy of CTA. RESULTS: SSM (96.8 ± 6%) and HSM (97.5 ± 8%) provided no significant differences in the overall diagnostic image quality. However, AS had significant influence on diagnostic image quality exclusively in SSM (B = 0.003; p = 0.0001), but not in HSM. Diagnostic image quality significantly decreased in SSM in patients with AS ≥2,000 (p = 0.03). SSM (sensitivity: 93.9%; specificity: 96.7%; PPV: 88.6%; NPV: 98.3%) and HSM (sensitivity: 97.4%; specificity: 94.3%; PPV: 86.0%; NPV: 99.0%) provided comparable diagnostic accuracy (p = n.s.). SSM yielded significantly lower radiation doses as compared to HSM (2.1 ± 2.0 vs. 5.1 ± 3.3 mSv; p = 0.0001) in age and BMI-matched cohorts. CONCLUSION: SSM in third-generation DSCT enables significant dose savings and provides robust diagnostic image quality in patients with AS ≤2000 independent of heart rate, heart rhythm or obesity.
EVALuna2:36049

Linear projection-based CEST parameter estimation - Glang, Felix; Fabian, Moritz S.; German, Alexander; Khakzar, Katrin; Mennecke, Angelika; Liebert, Andrzej; Herz, Kai; Liebig, Patrick; Kasper, Burkhard S.; Schmidt, Manuel; Zuazua Iriondo, Enrique; Nagel, Armin M.; et al. (NMR in Biomedicine, 2022)
Isolated evaluation of multi-parametric in vivo CEST MRI often requires complex computational processing for both correction of B0 and B1 inhomogeneity and contrast generation. For that, sufficiently densely sampled Z-spectra need to be acquired. The list of acquired frequency offsets largely determines the total CEST acquisition time, while potentially representing redundant information. In this work, a linear projection-based multi parametric CEST evaluation method is introduced that offers fast B0 and B1 inhomogeneity correction, contrast generation and feature selection for CEST data, enabling reduction of the overall measurement time. To that end, CEST data acquired at 7T in 6 healthy subjects and in one brain tumor patient were conventionally evaluated by interpolation-based inhomogeneity correction and Lorentzian curve fitting. Linear regression was used to obtain coefficient vectors that directly map uncorrected data to corrected Lorentzian target parameters. L1 regularization was applied to find subsets of the originally acquired CEST measurements that still allow for such a linear projection mapping. The linear projection method allows fast and interpretable mapping from acquired raw data to contrast parameters of interest, generalizing from healthy subject training data to unseen healthy test data and to the tumor patient dataset. The L1 regularization method shows that a fraction of the acquired CEST measurements is sufficient to preserve tissue contrasts, offering up to 2.8-fold reduction of scan time. Similar observations as for the 7T data can be made for data from a clinical 3T scanner. Being a fast and interpretable computation step, the proposed method is complementary to neural networks, which have been recently employed for similar purposes. The scan time acceleration offered by the L1 regularization (‘CEST-LASSO’) constitutes a step towards better applicability of multi parametric CEST protocols in clinical context.<br
Keywords: chemical exchange saturation transfer (CEST); feature selection; LASSO; APT; NOE; linear projection

Local control of perivascular malignant liver lesions using percutaneous irreversible electroporation: initial experiences - Eller, Achim; Schmid, Andrea; Schmidt, Joachim; May, Matthias; Brand, Michael; Saake, Marc; Uder, Michael; Lell, Michael (Cardiovascular and Interventional Radiology, 2015)
This study was designed to assess efficacy and safety in the treatment of perivascular malignant liver lesions using percutaneous, computed tomography (CT)-guided irreversible electroporation (IRE).Fourteen patients (mean age 58 ± 11 years) with 18 malignant liver lesions were consecutively enrolled in this study. IRE was performed in patients not eligible for surgery and lesions abutting large vessels or bile ducts. Follow-up exams were performed using multislice-CT (MS-CT) or MRI.Medium lesion diameter was 20 ± 5 mm. Ten of 14 (71 %) were successfully treated with no local recurrence to date (mean follow-up 388 ± 160 days). One case left initial tumor control unclear and additional RFA was performed 4 weeks after IRE. Complications occurred in 4 of 14 (29 %) cases. In one case, intervention was terminated and abdominal bleeding required laparotomy. In two cases, a postinterventional hematothorax required intervention. In another case, abdominal bleeding could be managed conservatively. No complications related to the bile ducts occurred.Percutaneous IRE seems to be effective in perivascular lesions but is associated with a higher complication rate compared with thermoablative techniques.
EVALuna2:14379

Localization of beta power decrease as measure for lateralization in pre-surgical language mapping with magnetoencephalography, compared with functional magnetic resonance imaging and validated by Wada test - Herfurth, Kirsten; Harpaz, Yuval; Rösch, Julie; Müller, Nadia; Walther, Katrin; Kaltenhaeuser, Martin; Pauli, Elisabeth; Goldstein, Abraham; Hamer, Hajo; Buchfelder, Michael; Dörfler, Arnd; Prell, Julian; et al. (Frontiers in Human Neuroscience, 2022)
Objective: Atypical patterns of language lateralization due to early reorganizational processes constitute a challenge in the pre-surgical evaluation of patients with pharmaco-resistant epilepsy. There is no consensus on an optimal analysis method used for the identification of language dominance in MEG. This study examines the concordance between MEG source localization of beta power desynchronization and fMRI with regard to lateralization and localization of expressive and receptive language areas using a visual verb generation task. Methods: Twenty-five patients with pharmaco-resistant epilepsy, including six patients with atypical language lateralization, and ten right-handed controls obtained MEG and fMRI language assessment. Fourteen patients additionally underwent the Wada test. We analyzed MEG beta power desynchronization in sensor (controls) and source space (patients and controls). Beta power decrease between 13 and 35 Hz was localized applying Dynamic Imaging of Coherent Sources Beamformer technique. Statistical inferences were grounded on cluster-based permutation testing for single subjects. Results: Event-related desynchronization of beta power in MEG was seen within the language-dominant frontal and temporal lobe and within the premotor cortex. Our analysis pipeline consistently yielded left language dominance with high laterality indices in controls. Language lateralization in MEG and Wada test agreed in all 14 patients for inferior frontal, temporal and parietal language areas (Cohen’s Kappa = 1, p < 0.001). fMRI agreed with Wada test in 12 out of 14 cases (85.7%) for Broca’s area (Cohen’s Kappa = 0.71, p = 0.024), while the agreement for temporal and temporo-parietal language areas were non-significant. Concordance between MEG and fMRI laterality indices was highest within the inferior frontal gyrus, with an agreement in 19/24 cases (79.2%), and non-significant for Wernicke’s area. Spatial agreement between fMRI and MEG varied considerably between subjects and brain regions with the lowest Euclidean distances within the inferior frontal region of interest. Conclusion: Localizing the desynchronization of MEG beta power using a verb generation task is a promising tool for the identification of language dominance in the pre-surgical evaluation of epilepsy patients. The overall agreement between MEG and fMRI was lower than expected and might be attributed to differences within the baseline condition. A larger sample size and an adjustment of the experimental designs are needed to draw further conclusions.
CRIS-Team Scopus Importer:2022-11-25
Keywords: beta power decrease; epilepsy; epilepsy surgery; functional magnetic resonance imaging (fMRI); intracarotid sodium amobarbital procedure (IAT); language lateralization; magnetoencephalography (MEG); Wada test

Localized B-0 shimming based on Na-23 MRI at 7 T - Gast, Lena; Henning, Anke; Hensel, Bernhard; Uder, Michael; Nagel, Armin Michael (Magnetic Resonance in Medicine, 2019)
Purpose To validate the feasibility of localized B-0 shimming based on B-0 maps acquired with sodium (Na-23) MRI. Methods A localized B-0 shimming routine based on a constrained regularized algorithm in combination with Na-23 MRI data acquired with a 3D density-adapted radial readout scheme was implemented on a 7T MR system. Measurements were performed using a dual-tuned Na-23/H-1 head coil. The quality of B-0 maps reconstructed from Na-23 images and the resulting shim values was examined depending on the acquisition duration between 10 minutes and 15 seconds to examine clinical applicability. The B-0 shimming based on Na-23 B-0 maps was performed both for phantom and human head of 6 healthy volunteers, and the resulting B-0 homogeneity was compared with the vendor-provided H-1 MRI-based gradient-echo brain shimming routine. Results The proposed Na-23 MRI-based shimming routine showed a reduction in B-0 variation comparable to the vendor-provided shim both in phantom and in vivo measurements. Within the examined multicompartment phantom, the B-0 variations could be reduced by up to 77% using the Na-23 MRI-based shim. In human head, B-0 variations were reduced by approximately 50% using an acquisition time of 15 seconds for the Na-23 B-0 maps and only 1 iteration of B-0 shimming. Conclusion The Na-23 MRI-based localized B-0 shimming is possible at 7 T within clinically acceptable acquisition durations (< 1 minute). It was shown that using the proposed Na-23 MRI-based shimming approach, the Na-23 image quality at ultrahigh field strength can be strongly improved.
CRIS-Team WoS Importer:2019-10-22

Locally renewing resident synovial macrophages provide a protective barrier for the joint - Culemann, Stephan; Grüneboom, Anika; Nicolás-Ávila, José Ángel; Weidner, Daniela; Lämmle, Katrin Franziska; Rothe, Tobias; Quintana, Juan A.; Kirchner, Philipp; Krljanac, Branislav; Eberhardt, Martin; Ferrazzi, Fulvia; Kretzschmar, Elke; et al. (Nature, 2019)
Macrophages are considered to contribute to chronic inflammatory diseases such as rheumatoid arthritis1. However, both the exact origin and the role of macrophages in inflammatory joint disease remain unclear. Here we use fate-mapping approaches in conjunction with three-dimensional light-sheet fluorescence microscopy and single-cell RNA sequencing to perform a comprehensive spatiotemporal analysis of the composition, origin and differentiation of subsets of macrophages within healthy and inflamed joints, and study the roles of these macrophages during arthritis. We find that dynamic membrane-like structures, consisting of a distinct population of CX3CR1+ tissue-resident macrophages, form an internal immunological barrier at the synovial lining and physically seclude the joint. These barrier-forming macrophages display features that are otherwise typical of epithelial cells, and maintain their numbers through a pool of locally proliferating CX3CR1− mononuclear cells that are embedded into the synovial tissue. Unlike recruited monocyte-derived macrophages, which actively contribute to joint inflammation, these epithelial-like CX3CR1+ lining macrophages restrict the inflammatory reaction by providing a tight-junction-mediated shield for intra-articular structures. Our data reveal an unexpected functional diversification among synovial macrophages and have important implications for the general role of macrophages in health and disease.
CRIS-Team Scopus Importer:2019-08-16

Local Vascularization during Orthodontic Tooth Movement in a Split Mouth Rat Model - A MRI Study - Proff, Peter; Schroeder, Agnes; Seyler, Lisa; Wolf, Franziska; Korkmaz, Yuksel; Bäuerle, Tobias; Gölz, Lina; Kirschneck, Christian (Biomedicines, 2020)
Orthodontic tooth movement to therapeutically align malpositioned teeth is supposed to impact blood flow in the surrounding tissues. Here, we evaluated actual vascularization in the tension area of the periodontal ligament during experimental tooth movement in rats (N = 8) with magnetic resonance imaging (MRI). We inserted an elastic band between the left upper first and the second rat molar; the right side was not treated and served as control. After four days of tooth movement, we recorded T1-weighted morphologic and dynamic-contrast-enhanced MRI sequences with an animal-specific 7 Tesla MRI to assess of local vascularization. Furthermore, we quantified osteoclasts and monocytes in the periodontal ligament, which are crucial for orthodontic tooth movement, root resorptions as undesirable side effects, as well as the extent of tooth movement using paraffine histology and micro-CT analysis. Data were tested for normal distribution with Shapiro-Wilk tests followed by either a two-tailed paired t-test or a Wilcoxon matched-pairs signed rank test. Significant orthodontic tooth movement was induced within the four days of treatment, as evidenced by increased osteoclast and monocyte activity in the periodontal ligament as well as by mu CT analysis. Contrast enhancement was increased at the orthodontically-treated side distally of the moved upper first left molar, indicating increased vascularization at the tension side of the periodontal ligament. Accordingly, we detected reduced time-to-peak and washout rates. Our study using MRI to directly assess local vascularization thus seems to confirm the hypothesis that perfusion is enhanced in tension zones of the periodontal ligament during orthodontic tooth movement.
CRIS-Team WoS Importer:2021-01-08

Long COVID: Association of Functional Autoantibodies against G-Protein-Coupled Receptors with an Impaired Retinal Microcirculation - Szewczykowski, Charlotte; Mardin, Christian; Lucio, Marianna; Wallukat, Gerd; Hoffmanns, Jakob; Schröder, Tim; Raith, Franziska; Rogge, Lennart; Heltmann, Felix; Moritz, Michael; Beitlich, Lorenz; Schottenhamml, Julia; et al. (International Journal of Molecular Sciences, 2022)
Long COVID (LC) describes the clinical phenotype of symptoms after infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Diagnostic and therapeutic options are limited, as the pathomechanism of LC is elusive. As the number of acute SARS-CoV-2 infections was and is large, LC will be a challenge for the healthcare system. Previous studies revealed an impaired blood flow, the formation of microclots, and autoimmune mechanisms as potential factors in this complex interplay. Since functionally active autoantibodies against G-protein-coupled receptors (GPCR-AAbs) were observed in patients after SARS-CoV-2 infection, this study aimed to correlate the appearance of GPCR-AAbs with capillary microcirculation. The seropositivity of GPCR-AAbs was measured by an established cardiomyocyte bioassay in 42 patients with LC and 6 controls. Retinal microcirculation was measured by OCT–angiography and quantified as macula and peripapillary vessel density (VD) by the Erlangen-Angio Tool. A statistical analysis yielded impaired VD in patients with LC compared to the controls, which was accentuated in female persons. A significant decrease in macula and peripapillary VD for AAbs targeting adrenergic β2-receptor, MAS-receptor angiotensin-II-type-1 receptor, and adrenergic α1-receptor were observed. The present study might suggest that a seropositivity of GPCR-AAbs can be linked to an impaired retinal capillary microcirculation, potentially mirroring the systemic microcirculation with consecutive clinical symptoms.
CRIS-Team Scopus Importer:2022-07-15
Keywords: chronic fatigue syndrome; COVID-19; functionally GPCR autoantibodies; glaucoma; Long-COVID syndrome; OCT–angiography

Longitudinal Change in Knee Cartilage Thickness and Function in Subjects with and without MRI-Diagnosed Cartilage Damage - Wisser, Anna; Lapper, Andreas; Roemer, Frank; Fuerst, David; Maschek, Susanne; Wirth, Wolfgang; Duda, Georg N.; Eckstein, Felix (Cartilage, 2020)
Objective. Cartilage damage diagnosed by magnetic resonance imaging (MRI) is highly prevalent in the population. In this article, we explore whether such cartilage damage is associated with greater longitudinal change in 3D cartilage thickness and knee function in subjects without (risk factors of) knee osteoarthritis. Design. Eighty-two knees of Osteoarthritis Initiative healthy reference cohort participants had baseline and 4-year follow-up MRI and knee function data. Baseline presence of semiquantitatively assessed MRI-based cartilage damage (MOAKS [MRI Osteoarthritis Knee Score] = grade 1.0) was recorded by an experienced radiologist. Longitudinal femorotibial cartilage thickness change was determined after segmentation, using location-independent methodology. Knee function was evaluated by patient-reported outcomes and functional performance measures. Statistical comparisons included analysis of covariance adjusting for age, sex, and body mass index. Results. Forty-five percent of the participants had cartilage damage in at least one femorotibial subregion; the cartilage thickness change score was 15% greater in participants with than in those without damage (1216 +/- 434 vs. 1058 +/- 277 mu m). This difference reached borderline statistical significance with and without adjustment for age, sex, and body mass index (P = 0.05). No significant differences in the change of patient-reported outcomes of knee function (PASE [physical activity score of the elderly] and WOMAC [Western Ontario McMaster Osteoarthritis Index]) or chair stand test results were detected. Of those without femorotibial damage, 58% had cartilage damage in at least one femoropatellar subregion; these had a 9% greater femorotibial cartilage change score than those without femoropatellar or femorotibial damage (difference not statistically significant). Conclusions. In the absence of osteoarthritis risk factors, semiquantitatively assessed MRI-based cartilage damage appears to be associated with greater longitudinal location-independent femorotibial cartilage thickness changes, but not with greater functional deteriorations.
CRIS-Team WoS Importer:2021-02-05

LONGITUDINAL CHANGE IN THE CENTRAL NERVOUS SYSTEM PAIN RESPONSE AFTER TREATMENT WITH CERTOLIZUMAB OR PLACEBO. A POST-HOC ANALYSIS FROM THE PRECEPRA TRIAL - Rech, Jürgen; Tascilar, K.; Schenker, Hannah; Hagen, Melanie; Sergeeva, Marina; Selvakumar, Mageshwar; Konerth, Laura; Prade, Jutta; Strobelt, Sandra; Schonau, V.; Valor, L.; Hueber, A.; et al. (ANNALS OF THE RHEUMATIC DISEASES, 2020)
CRIS-Team WoS Importer:2020-08-21

Longitudinally Assessed Structural Abnormalities on MRI and Relative Contributions to Risk of Incident Radiographic Knee Osteoarthritis over 10 Years of Follow-up - Kwoh, C. Kent; Guermazi, Ali; Ashbeck, Erin; Hu, Chengcheng; Bedrick, Edward; Sharma, Leena; Eaton, Charles; Hochberg, Marc; Jackson, Rebecca; Mcalindon, Timothy; Nevitt, Michael; Cauley, Jane; et al. (ARTHRITIS & RHEUMATOLOGY, 2020)
CRIS-Team WoS Importer:2021-01-15

Longitudinal Sodium MRI of Multiple Sclerosis Lesions: Is there Added Value of Sodium Inversion Recovery MRI - Mennecke, Angelika; Nagel, Armin Michael; Huhn, Konstantin; Linker, Ralf; Schmidt, Manuel; Rothhammer, Veit; Wilferth, Tobias; Linz, Peter; Wegmann, Julius; Eisenhut, Felix; Engelhorn, Tobias; Dörfler, Arnd (Journal of Magnetic Resonance Imaging, 2021)
Background Sodium enhancement has been demonstrated in multiple sclerosis (MS) lesions. Purpose To investigate sodium MRI with and without an inversion recovery pulse in acute MS lesions in an MS relapse and during recovery. Study Type Prospective. Subjects Twenty-nine relapsing-remitting MS patients with an acute relapse were included. Field Strength/Sequence A 3D density-adapted radial sodium sequence at 3 T using a dual-tuned (Na-23/H-1) head coil. Assessment Full-brain images of the tissue sodium concentration (TSC1, n = 29) and a sodium inversion recovery sequence (SIR1, n = 20) at the beginning of the anti-inflammatory therapy and on medium-term follow-up visits (days 27-99, n = 12 [TSC], n = 5 [SIR]) were measured. Regions of interest (RoIs) with contrast enhancement (T1CE+) and without change in T1-weighted imaging (FL + T1n) were normalized (nTSC and nSIR). To gain insight on the origin of the TSC enhancement at time point 1, it is investigated whether the nTSC enhancement of the lesions is accompanied by a change of the respective nSIR. Potential prognostic value of nSIR1 is examined referring to the nTSC progression. Statistical Tests nTSC and nSIR were compared regarding the type of lesion and the time point using a one-way ANOVA. Pearson's correlation coefficient was calculated for nTSC over nSIR and for nTSC1-nTSC2 over nSIR1. A P-value At the first measurement, all lesion types showed increased nTSC, while nSIR was decreased in the FL + T(1)n and the T1CE+ lesions in comparison to the normal-appearing white matter. For acute lesions, the difference between nTSC at baseline and nTSC at time point 2 showed a significant correlation with the baseline nSIR. Data Conclusion At time point 1, nTSC is increased, while nSIR is unchanged or decreased in the lesions. The mean sodium IR signal at baseline correlates with recovery or progression of an acute lesion. Evidence Level 2 Technical Efficacy Stage 4
CRIS-Team WoS Importer:2021-07-23

Longitudinal Spread Analysis of Patients with Glioblastoma: high Prevalence of discontinuous Tumor Foci with no strong Relation to the Fibrous Tract System - Schmitter, Charlotte; Weissmann, Thomas; Mansoorian, Sina; Lettmaier, Sebastian; Semrau, Sabine; Schmidt, Manfred; Heiß, Rafael; Frey, Benjamin; Bert, Christoph; Fietkau, Rainer; Putz, Florian (STRAHLENTHERAPIE UND ONKOLOGIE, 2021)
CRIS-Team WoS Importer:2021-07-16

Longitudinal validation of periarticular bone area and 3D shape as biomarkers for knee OA progression? Data from the FNIH OA Biomarkers Consortium - Hunter, David; Nevitt, Michael; Lynch, John; Kraus, Virginia Byers; Katz, Jeffrey N.; Collins, Jamie E.; Bowes, Mike; Guermazi, Ali; Roemer, Frank; Losina, Elena (Annals of the Rheumatic Diseases, 2016)
To perform a longitudinal validation study of imaging bone biomarkers of knee osteoarthritis (OA) progression.We undertook a nested case-control study within the Osteoarthritis Initiative in knees (one knee per subject) with a Kellgren and Lawrence grade of 1-3. Cases were defined as knees having the combination of medial tibiofemoral radiographic progression and pain progression at the 24-month, 36-month or 48-month follow-up compared with baseline. Controls (n=406) were eligible knees that did not meet both endpoint criteria and included 200 with neither radiographic nor pain progression, 103 with radiographic progression only and 103 with pain progression only. Bone surfaces in medial and lateral femur, tibia and patella compartments were segmented from MR images using active appearance models. Independent variables of primary interest included change from baseline to 24 months in (1) total area of bone and (2) position on three-dimensional (3D) bone shape vectors that discriminate OA versus non-OA shapes. We assessed the association of bone markers changes over 24 months with progression using logistic regression.24-month changes in bone area and shape in all compartments were greater in cases than controls, with ORs of being a case per 1 SD increase in bone area ranging from 1.28 to 1.71 across compartments, and per 1 SD greater change in 3D shape vectors ranging from 1.22 to 1.64. Bone markers were associated most strongly with radiographic progression and only weakly with pain progression.In knees with mild-to-moderate radiographic OA, changes in bone area and shape over 24 months are associated with the combination of radiographic and pain progression over 48 months. This finding of association with longer term clinical outcome underscores their potential for being an efficacy of intervention biomarker in clinical trials.
EVALuna2:14629

Long-Term Complications and Influence on Outcome in Patients Surviving Spontaneous Subarachnoid Hemorrhage - Gerner, Stefan; Reichl, Jonathan; Custal, Christina; Brandner, Sebastian; Eyüpoglu, Ilker Yasin; Lücking, Hannes; Hölter, Philip; Kallmünzer, Bernd; Huttner, Hagen (Cerebrovascular Diseases, 2020)
BACKGROUND: While the short-term clinical outcome of patients with subarachnoid hemorrhage (SAH) is well described, there are limited data on long-term complications and their impact on social reintegration. This study aimed to assess the frequency of complications post-SAH and to investigate whether these complications attribute to functional and self-reported outcomes as well as the ability to return to work in these patients. METHODS: This retrospective single-center study included patients with atraumatic SAH over a 5-year period at a tertiary care center. Patients received a clinical follow-up for 12 months. In addition to demographics, imaging data, and parameters of acute treatment, the rate and extent of long-term complications after SAH were recorded. The functional outcome was assessed using the modified Rankin Scale (mRS; favorable outcome defined as mRS = 0-2). Further outcomes comprised self-reported subjective health measured by the EQ-5D and return to work for SAH patients with appropriate age. Multivariable analyses including in-hospital parameters and long-term complications were conducted to identify parameters independently associated with outcomes in SAH survivors. RESULTS: This study cohort consisted of 505 SAH patients of whom 405 survived the follow-up period of 12 months (i.e., mortality rate of 19.8%). Outcome data were available in 359/405 (88.6%) patients surviving SAH. At 12 months, a favorable functional outcome was achieved in 287/359 (79.9%) and 145/251 (57.8%) SAH patients returned to work. The rates of post-acute complications were headache (32.3%), chronic hydrocephalus requiring permanent ventriculoperitoneal shunting (VP shunt 25.4%) and epileptic seizures (9.5%). Despite patient's and clinical characteristics, both presence of epilepsy and need for VP shunt were independently and negatively associated with a favorable functional outcome (epilepsy: adjusted odds ratio [aOR] (95% confidence interval [95% CI]): 0.125 [0.050-0.315]; VP shunt: 0.279 [0.132-0.588]; both p < 0.001) as well as with return to work (aOR [95% CI]: epilepsy 0.195 [0.065-0.584], p = 0.003; VP shunt 0.412 [0.188-0.903], p = 0.027). Multivariable analyses revealed presence of headache, VP shunt, or epilepsy to be significantly related to subjective health impairment (aOR [95% CI]: headache 0.248 [0.143-0.430]; epilepsy 0.223 [0.085-0.585]; VP shunt 0.434 [0.231-0.816]; all p < 0.01). CONCLUSIONS: Long-term complications occur frequently after SAH and are associated with an impairment of functional and social outcomes. Further studies are warranted to investigate if treatment strategies specifically targeting these complications, including preventive aspects, may improve the outcomes after SAH.
CRIS-Team Scopus Importer:2020-08-07
Keywords: Long-term complications; Post-stroke outcomes; Social participation; Subarachnoid hemorrhage

Long-term control with chemoradiation of initially metastatic mixed adenoneuroendocrine carcinoma of the rectum: A case report - Semrau, S.; Agaimy, Abbas; Pavel, Marianne Ellen; Lubgan, Dorota; Schmidt, Daniela; Golcher, H.; Grützmann, Robert; Fietkau, Rainer; Cavallaro, Alexander Josef (Journal of Medical Case Reports, 2019)
Background: Mixed adenoneuroendocrine carcinomas are highly malignant tumors with both adenocarcinomatous and neuroendocrine components. They can originate in any organ but are more common in the rectum. Due to their rarity, current treatment recommendations for mixed adenoneuroendocrine carcinoma are based on limited data and follow general guidelines for the management of adenocarcinomas and neuroendocrine neoplasms. Uncertainty regarding the efficacy of the available local and systemic treatment strategies is a compounding issue. Even those patients with locally limited disease have a relatively short life expectancy. In this report, we describe a case of deep rectal mixed adenoneuroendocrine carcinoma with long survival after chemoradiation. Case presentation: A 48-year-old Caucasian woman was diagnosed with a grade 3 rectal adenocarcinoma combined with a poorly differentiated large cell neuroendocrine carcinoma component and synchronous metastases (cT3cN1cM1) in both lobes of the liver in 2012. She received concomitant chemoradiotherapy followed by four additional cycles of cisplatin plus irinotecan. Initial treatment induced complete remission of the rectal tumor and liver metastases. Consequently, it was not necessary to surgically resect the primary tumor or any of the metastases. Three months after the end of treatment, one metastasis in the first segment of the liver showed regrowth, and stereotactic body radiotherapy of the metastasis and chemotherapy resulted in a clinical complete response. The patient has been recurrence-free for more than 5 years. Conclusions: Extended long-term control of a poorly differentiated metastatic (stage IV) mixed adenoneuroendocrine carcinoma is rare. The multimodal first- and second-line regimens of radiotherapy and chemotherapy described in this case report represent a new therapeutic approach. Encouraged by the results in this case, we compiled a review of the literature on mixed adenoneuroendocrine carcinoma.
CRIS-Team Scopus Importer:2019-05-14
Keywords: Chemoradiation; MANEC; Rectum; SBRT

Long-term course of anterior spinal cord herniation presenting with an upper motor neuron syndrome: Case report illustrating diagnostic and therapeutic implications - Regensburger, Martin; Schlachetzki, Johannes; Klekamp, Jörg; Dörfler, Arnd; Winkler, Jürgen (BMC Neurology, 2020)
Background: Anterior spinal cord herniation (aSCH) is a rare cause of myelopathy which may present as pure motor syndrome and mimic other degenerative diseases of the spinal cord. In slowly progressive cases, diagnosis may be impeded by equivocal imaging results and mistaken for evolving upper motor neuron disease. As early imaging studies are lacking, we aimed to provide a detailed description of imaging and neurophysiology findings in a patient with aSCH, focusing on the early symptomatic stages. Case presentation: We here present the case of a 51-year old male patient with an episode of pain in the right trunk and a normal spinal MRI. After a symptom-free interval of 8 years, spasticity and paresis evolved in the right leg. There was subtle ventral displacement and posterior indentation of the thoracic spinal cord on MRI which, in retrospect, was missed as an early sign of aSCH. After another 3 years, symptoms spread to the left leg and a sensory deficit of the trunk became evident. Follow-up MRI now clearly showed an aSCH. Neurosurgical intervention consisted of remobilization of the herniated spinal cord and patch closure of the dura defect. Over the following years, motor and sensory symptoms partially improved. Conclusions: The history of this patient with aSCH illustrates the importance of careful longitudinal clinical follow-up with repeated imaging studies in progressive upper motor neuron syndromes. Specific attention should be paid to a history of truncal pain and to MRI findings of a ventrally displaced spinal cord. Neurosurgical intervention may halt the progression of herniation.
CRIS-Team Scopus Importer:2020-09-18
Keywords: Case Report; Evoked potentials; Spasticity; Spinal cord herniation

Long term use of analgesics and risk of osteoarthritis progressions and knee replacement: propensity score matched cohort analysis of data from the Osteoarthritis Initiative - Hafezi-Nejad, N.; Guermazi, Ali; Roemer, Frank; Eng, J.; Zikria, B.; Demehri, S. (Osteoarthritis and Cartilage, 2016)
To determine the association between the long-term use of analgesics and progression of osteoarthritis (OA) as evidenced by up to 3-years follow-up worsening of radiographic Kellgren-Lawrence (KL) grade and incidence of knee replacement (KR).Using nearest neighbor matching of the propensity scores with caliper in the Osteoarthritis Initiative (OAI) cohort, 173 index (Analgesic +) and 173 referent (Analgesic -) subjects were included. Analgesic + and - subjects had analgesics in all and none of their visits, respectively. Analgesic + and - subjects were balanced in their demographics, baseline, first, second and third year body mass index (BMI), Western Ontario and McMaster (WOMAC) total score, Physical and Mental health summary scales (SF-12), Physical Activity Scale for the Elderly (PASE) and Charleston Comorbidity Scale. Analgesic + and - subjects were also matched for baseline radiographic KL grade. Interval increase in the KL grade and incidence of KR were defined as the outcome.Included subjects had average 6.5 years of follow-up. By the third year, 44 subjects had an interval increase in the KL grade; 29 in Analgesic + and 15 among Analgesic - subjects (P = 0.024). By the eighth-year, 41 subjects had their first KR; 29 in Analgesic + and 12 among Analgesic - subjects (P = 0.005). Hazard Ratio (HR) of OA progression and KR for Analgesic + subjects was 1.91 (1.02-3.57) and 2.57 (1.31-5.04), respectively.Long-term use of analgesics may be associated with radiographic progression of knee OA and increased risk of future KR.
EVALuna2:14690

Loss of Mpdz impairs ependymal cell integrity leading to perinatal-onset hydrocephalus in mice - Feldner, Anja; Adam, M. Gordian; Tetzlaff, Fabian; Moll, Iris; Komljenovic, Dorde; Sahm, Felix; Bäuerle, Tobias; Ishikawa, Hiroshi; Schroten, Horst; Korff, Thomas; Hofmann, Ilse; Wolburg, Hartwig; et al. (Embo Molecular Medicine, 2017)
Hydrocephalus is a common congenital anomaly. LCAM1 and MPDZ (MUPP1) are the only known human gene loci associated with non-syndromic hydrocephalus. To investigate functions of the tight junction-associated protein Mpdz, we generated mouse models. Global Mpdz gene deletion or conditional inactivation in Nestin-positive cells led to formation of supratentorial hydrocephalus in the early postnatal period. Blood vessels, epithelial cells of the choroid plexus, and cilia on ependymal cells, which line the ventricular system, remained morphologically intact in Mpdz-deficient brains. However, flow of cerebrospinal fluid through the cerebral aqueduct was blocked from postnatal day 3 onward. Silencing of Mpdz expression in cultured epithelial cells impaired barrier integrity, and loss of Mpdz in astrocytes increased RhoA activity. In Mpdz-deficient mice, ependymal cells had morphologically normal tight junctions, but expression of the interacting planar cell polarity protein Pals1 was diminished and barrier integrity got progressively lost. Ependymal denudation was accompanied by reactive astrogliosis leading to aqueductal stenosis. This work provides a relevant hydrocephalus mouse model and demonstrates that Mpdz is essential to maintain integrity of the ependyma.
EVALuna2:14699

Loss of stromal JUNB does not affect tumor growth and angiogenesis - Braun, Jennifer; Strittmatter, Karin; Nuebel, Tobias; Komljenovic, Dorde; Sator-Schmitt, Melanie; Bäuerle, Tobias; Angel, Peter; Schorpp-Kistner, Marina (International Journal of Cancer, 2014)
The transcription factor AP-1 subunit JUNB has been shown to play a pivotal role in angiogenesis. It positively controls angiogenesis by regulating Vegfa as well as the transcriptional regulator Cbfb and its target Mmp13. In line with these findings, it has been demonstrated that tumor cell-derived JUNB promotes tumor growth and angiogenesis. In contrast to JUNB's function in tumor cells, the role of host-derived stromal JUNB has not been elucidated so far. Here, we show that ablation of Junb in stromal cells including endothelial cells (ECs), vascular smooth muscle cells (SMCs) and fibroblasts does not affect tumor growth in two different syngeneic mouse models, the B16-F1 melanoma and the Lewis lung carcinoma model. In-depth analyses of the tumors revealed that tumor angiogenesis remains unaffected as assessed by measurements of the microvascular density and relative blood volume in the tumor. Furthermore, we could show that the maturation status of the tumor vasculature, analyzed by the SMC marker expression, ?-smooth muscle actin and Desmin, as well as the attachment of pericytes to the endothelium, is not changed upon ablation of Junb. Taken together, these results indicate that the pro-angiogenic functions of stromal JUNB are well compensated with regard to tumor angiogenesis and tumor growth.
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Low-Dose CT of the Paranasal Sinuses: Minimizing X-Ray Exposure with Spectral Shaping - Wüst, Wolfgang; May, Matthias; Saake, Marc; Brand, Michael; Uder, Michael; Lell, Michael (European Radiology, 2016)
Shaping the energy spectrum of the X-ray beam has been shown to be beneficial in low-dose CT. This study's aim was to investigate dose and image quality of tin filtration at 100 kV for pre-operative planning in low-dose paranasal CT imaging in a large patient cohort.In a prospective trial, 129 patients were included. 64 patients were randomly assigned to the study protocol (100 kV with additional tin filtration, 150mAs, 192x0.6-mm slice collimation) and 65 patients to the standard low-dose protocol (100 kV, 50mAs, 128 × 0.6-mm slice collimation). To assess the image quality, subjective parameters were evaluated using a five-point scale. This scale was applied on overall image quality and contour delineation of critical anatomical structures.All scans were of diagnostic image quality. Bony structures were of good diagnostic image quality in both groups, soft tissues were of sufficient diagnostic image quality in the study group because of a high level of noise. Radiation exposure was very low in both groups, but significantly lower in the study group (CTDIvol 1.2 mGy vs. 4.4 mGy, p < 0.001).Spectral optimization (tin filtration at 100 kV) allows for visualization of the paranasal sinus with sufficient image quality at a very low radiation exposure.o Spectral optimization (tin filtration) is beneficial to low-dose parasinus CT o Tin filtration at 100 kV yields sufficient image quality for pre-operative planning o Diagnostic parasinus CT can be performed with an effective dose <0.05 mSv.
EVALuna2:14599

Low-dose dual-source CT angiography with iterative reconstruction for coronary artery stent evaluation - Eisentopf, Jasmin; Achenbach, Stephan; Ulzheimer, Stefan; Layritz, Christian; Wüst, Wolfgang; May, Matthias; Lell, Michael; Ropers, Dieter; Klinghammer, Lutz; Daniel, Werner; Pflederer, Tobias (Journal of the American College of Cardiology : Cardiovascular imaging, 2013)
Objectives: The purpose of this study was to evaluate the image quality and diagnostic accuracy of very low-dose, dual-source computed tomography (DSCT) angiography for the evaluation of coronary stents. Background: Iterative reconstruction (IR) leads to substantial reduction of image noise and hence permits the use of very low-dose data acquisition protocols in coronary computed tomography angiography. Methods: Fifty symptomatic patients with 87 coronary stents (diameter 3.0 ± 0.4 mm) underwent coronary DSCT angiography (heart rate, 60 ± 6 beats/min; prospectively electrocardiography-triggered axial acquisition; 80 kV, 165 mA, 2 × 128 × 0.6-mm collimation; 60 ml of contrast at 6 ml/s) before invasive coronary angiography. DSCT images were reconstructed using both standard filtered back projection and a raw data-based IR algorithm (SAFIRE, Siemens Healthcare, Forchheim, Germany). Subjective image quality (4-point scale from 0 [nondiagnostic] to 3 [excellent image quality]), image noise, contrast-to-noise ratio as well as the presence of in-stent stenosis >50% were independently determined by 2 observers. Results: The median dose-length product was 23.0 (22.0; 23.0) mGy · cm (median estimated effective dose of 0.32 [0.31; 0.32] mSv). IR led to significantly improved image quality compared with filtered back projection (image quality score, 1.8 ± 0.6 vs. 1.5 ± 0.5, p < 0.05; image noise, 70 Hounsfield units [62; 80 Hounsfield units] vs. 96 Hounsfield units [82; 113 Hounsfield units], p < 0.001; contrast-to-noise ratio, 11.0 [9.6; 12.4] vs. 8.0 [6.2; 9.3], p < 0.001). To detect significant coronary stenosis in filtered back projection reconstructions, the sensitivity, specificity, positive predictive value, and negative predictive value were 97% (32 of 33), 53% (9 of 17), 80% (32 of 40), and 90% (9 of 10) per patient, respectively; 89% (43 of 48), 79% (120 of 152), 57% (42 of 74), and 96% (121 of 126) per vessel, respectively; and 85% (12 of 14), 69% (51 of 73), 32% (11 of 34), and 96% (51 of 53) per stent, respectively. In reconstructions obtained by IR, the corresponding values were 100% (33 of 33), 65% (11 of 17), 85% (33 of 39), and 100% (11 of 11) per patient, respectively; 96% (46 of 48), 84% (129 of 152), 66% (47 of 71), and 98% (127 of 129) per vessel, respectively; and 100% (14 of 14), 75% (55 of 73), 44% (14 of 32), and 100% (55 of 55) per stent, respectively. These differences were not significant. Conclusions: In selected patients, prospectively electrocardiography-triggered image acquisition with 80-kV tube voltage and low current in combination with IR permits the evaluation of patients with implanted coronary artery stents with reasonable diagnostic accuracy at very low radiation exposure. © 2013 American College of Cardiology Foundation.
CRIS-Team Scopus Importer:2023-03-08
Keywords: coronary CT angiography; iterative reconstruction; low dose; stent

Low-Field Magnetic Resonance Imaging: A New Generation of Breakthrough Technology in Clinical Imaging - Heiß, Rafael; Nagel, Armin Michael; Laun, Frederik Bernd; Uder, Michael; Bickelhaupt, Sebastian (Investigative Radiology, 2021)
ABSTRACT: Magnetic resonance imaging (MRI) plays a pivotal role in diagnostic imaging. In today's clinical environment, scanners with field strengths of 1.5 to 3 T are most commonly used. However, recent technological advancements might help to augment the clinical usage and availability of MRI via the introduction of high-performance low-field MRI systems (ranging from 0.1-0.55 T in current systems). The combination of low field strength and high-performance hardware is characterized by increased flexibility, excellent quality of results, and reduced cost. This review discusses the multifaceted potential advantages of a new generation of high-performance low-field MRI systems and presents the potential impact of such systems in terms of socioeconomic benefits as well as positive effects on patient care.
CRIS-Team Scopus Importer:2021-11-05

Low-Risk Women with Suspicious Microcalcifications in Mammography-Can an Additional Breast MRI Reduce the Biopsy Rate? - Pöschke, Patrik; Wenkel, Evelyn; Hack, Caroline; Beckmann, Matthias; Uder, Michael; Ohlmeyer, Sabine (Diagnostics, 2023)
Background: In the German Mammography Screening Program, 62% of ductal carcinoma in situ (DCIS) and 38% of invasive breast cancers are associated with microcalcifications (MCs). Vacuum-assisted stereotactic breast biopsies are necessary to distinguish precancerous lesions from benign calcifications because mammographic discrimination is not possible. The aim of this study was to investigate if breast magnetic resonance imaging (MRM) could assist the evaluation of MCs and thus help reduce biopsy rates. Methods: In this IRB-approved study, 58 women (mean age 58 +/- 24 years) with 59 suspicious MC clusters in the MG were eligible for this prospective single-center trial. Additional breast magnetic resonance imaging (MRI) was conducted before biopsy. Results: The breast MRI showed a sensitivity of 86%, a specificity of 84%, a positive predictive value (PPV) of 75% and a negative predictive value (NPV) of 91% for the differentiation between benign and malignant in these 59 MCs found with MG. Breast MRI in addition to MG could increase the PPV from 36% to 75% compared to MG alone. The MRI examination led to nine additional suspicious classified lesions in the study cohort. A total of 55% (5/9) of them turned out to be malignant. A total of 32 of 59 (54 %) women with suspicious MCs and benign histology were classified as non-suspicious by MRI. Conclusion: An additionally performed breast MRI could have increased the diagnostic reliability in the assessment of MCs. Further, in our small cohort, a considerable number of malignant lesions without mammographically visible MCs were revealed.
CRIS-Team WoS Importer:2023-04-14

Lumbrical muscle tear: clinical presentation, imaging findings and outcome - Lutter, Christoph; Schweizer, Andreas; Roemer, Frank; Bayer, Thomas; Schöffl, Volker (Journal of Hand Surgery-European Volume, 2018)
The incidence of lumbrical muscle tear is increasing due to the popularity of climbing sport. We reviewed data from 60 consecutive patients with a positive lumbrical stress test, including clinical examination, ultrasound and clinical outcomes in all patients, and magnetic resonance imaging in 12 patients. Fifty-seven patients were climbers. Lumbrical muscle tears were graded according to the severity of clinical and imaging findings as Grade I-III injuries. Eighteen patients had Grade I injuries (microtrauma), 32 had Grade II injuries (muscle fibre disruption) and 10 had Grade III injuries (musculotendinous disruption). The treatment consisted of adapted functional therapy. All patients completely recovered and were able to return to climbing. The healing period in Grade III injuries was significantly longer than in the patients with Grade I or II injuries ( p < 0.001). We recommend evaluation of specific clinical and imaging findings to grade the injuries and to determine suitable therapy. LEVEL OF EVIDENCE: IV.
EVALuna2:36237

Lungenbildgebung in der Niederfeld-Magnetresonanztomographie - Hinsen, Maximilian; Heiß, Rafael; Nagel, Armin Michael; Levy, Simon; Uder, Michael; Bickelhaupt, Sebastian; May, Matthias (Radiologe, 2022)
Background: Lung magnetic resonance imaging (MRI) examinations are challenging and have not become established in the routine clinical setting. Recent developments in low-field MRI, combined with computer-assisted algorithms for acquisition and evaluation, promise new perspectives for imaging of pulmonary diseases. Objectives: This review aims to inform about the physical advantages of low-field MRI for imaging the lungs, provide a review of the sparse literature, and present first results from a new low-field MRI scanner. Materials and methods: This article provides information on the physical principles, an review of the literature, and our first experiences in lung imaging on a modern 0.55 T MRI. Conclusion: Low-field MRI (< 1 T) may have technical and economic advantages over higher field strength MRI in lung imaging. The physical preconditions of low-field MRI are advantageous for imaging the lungs due to reduced susceptibility effects, increased transversal relaxation times, and lower specific absorption rates. The lower investment and operating costs may enable increased availability and sustainability. Combining modern sequences and computer-based image processing may expand beyond morphological imaging by providing spatially and temporally resolved functional examinations of the lung parenchyma without ionizing radiation. In critical scenarios, like screening and short-term follow-up examinations, and patients at risk, low-field MRI may bridge the gap. These indications may include acute and chronic pulmonary diseases in pediatric patients and suspected pulmonary embolisms in pregnant women.
CRIS-Team Scopus Importer:2022-04-29
Keywords: Field strength; Functional analysis; Image quality; Low-field system; Lung imaging

Lungenbildgebung in der Niederfeld-Magnetresonanztomographie - Hinsen, Maximilian; Heiß, Rafael; Nagel, Armin Michael; Levy, Simon; Uder, Michael; Bickelhaupt, Sebastian; May, Matthias (Zeitschrift für Pneumologie, 2024)
Background: Lung magnetic resonance imaging (MRI) examinations are challenging and have not become established in the routine clinical setting. Recent developments in low-field MRI, combined with computer-assisted algorithms for acquisition and evaluation, promise new perspectives for imaging of pulmonary diseases. Objectives: This review aims to inform about the physical advantages of low-field MRI for imaging the lungs, provide a review of the sparse literature, and present first results from a new low-field MRI scanner. Materials and methods: This article provides information on the physical principles, an review of the literature, and our first experiences in lung imaging on a modern 0.55 T MRI. Conclusion: Low-field MRI (< 1 T) may have technical and economic advantages over higher field strength MRI in lung imaging. The physical preconditions of low-field MRI are advantageous for imaging the lungs due to reduced susceptibility effects, increased transversal relaxation times, and lower specific absorption rates. The lower investment and operating costs may enable increased availability and sustainability. Combining modern sequences and computer-based image processing may expand beyond morphological imaging by providing spatially and temporally resolved functional examinations of the lung parenchyma without ionizing radiation. In critical scenarios, like screening and short-term follow-up examinations, and patients at risk, low-field MRI may bridge the gap. These indications may include acute and chronic pulmonary diseases in pediatric patients and suspected pulmonary embolisms in pregnant women.
CRIS-Team Scopus Importer:2024-01-26
Keywords: Field strength; Functional analysis; Image quality; Low-field system; Lung imaging

Lung Nodule Detection With Modern Low-Field MRI (0.55 T) in Comparison to CT. - Hinsen, Maximilian; Nagel, Armin M.; May, Matthias; Wiesmüller, Marco; Uder, Michael; Heiß, Rafael (Investigative Radiology, 2024)
OBJECTIVES: The aim of this study was to evaluate the accuracy of modern low-field magnetic resonance imaging (MRI) for lung nodule detection and to correlate nodule size measurement with computed tomography (CT) as reference. MATERIALS AND METHODS: Between November 2020 and July 2021, a prospective clinical trial using low-field MRI at 0.55 T was performed in patients with known pulmonary nodules from a single academic medical center. Every patient underwent MRI and CT imaging on the same day. The primary aim was to evaluate the detection accuracy of pulmonary nodules using MRI with transversal periodically rotated overlapping parallel lines with enhanced reconstruction in combination with coronal half-Fourier acquired single-shot turbo spin-echo MRI sequences. The secondary outcome was the correlation of the mean lung nodule diameter with CT as reference according to the Lung Imaging Reporting and Data System. Nonparametric Mann-Whitney U test, Spearman rank correlation coefficient, and Bland-Altman analysis were applied to analyze the results. RESULTS: A total of 46 participants (mean age ± SD, 66 ± 11 years; 26 women) were included. In a blinded analysis of 964 lung nodules, the detection accuracy was 100% for those ≥6 mm (126/126), 80% (159/200) for those ≥4-<6 mm, and 23% (147/638) for those <4 mm in MRI compared with reference CT. Spearman correlation coefficient of MRI and CT size measurement was r = 0.87 ( P < 0.001), and the mean difference was 0.16 ± 0.9 mm. CONCLUSIONS: Modern low-field MRI shows excellent accuracy in lesion detection for lung nodules ≥6 mm and a very strong correlation with CT imaging for size measurement, but could not compete with CT in the detection of small nodules.
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Lymph node detection and segmentation in chest CT data using discriminative learning and a spatial prior - Feulner, Johannes; Zhou, S. Kevin; Hammon, Matthias; Hornegger, Joachim; Comaniciu, Dorin (Medical Image Analysis, 2012)
Lymph nodes have high clinical relevance and routinely need to be considered in clinical practice. Automatic detection is, however, challenging due to clutter and low contrast. In this paper, a method is presented that fully automatically detects and segments lymph nodes in 3-D computed tomography images of the chest. Lymph nodes can easily be confused with other structures, it is therefore vital to incorporate as much anatomical prior knowledge as possible in order to achieve a good detection performance. Here, a learned prior of the spatial distribution is used to model this knowledge. Different prior types with increasing complexity are proposed and compared to each other. This is combined with a powerful discriminative model that detects lymph nodes from their appearance. It first generates a number of candidates of possible lymph node center positions. Then, a segmentation method is initialized with a detected candidate. The graph cuts method is adapted to the problem of lymph nodes segmentation. We propose a setting that requires only a single positive seed and at the same time solves the small cut problem of graph cuts. Furthermore, we propose a feature set that is extracted from the segmentation. A classifier is trained on this feature set and used to reject false alarms. Cross-validation on 54 CT datasets showed that for a fixed number of four false alarms per volume image, the detection rate is well more than doubled when using the spatial prior. In total, our proposed method detects mediastinal lymph nodes with a true positive rate of 52.0% at the cost of only 3.1 false alarms per volume image and a true positive rate of 60.9% with 6.1 false alarms per volume image, which compares favorably to prior work on mediastinal lymph node detection. © 2012 Elsevier B.V. All rights reserved.

Lymph node detection in 3-D chest CT using a spatial prior probability - Feulner, Johannes; Zhou, S. Kevin; Huber, Martin; Hornegger, Joachim; Comaniciu, Dorin; Cavallaro, Alexander Josef (2010 IEEE Computer Society Conference on Computer Vision and Pattern Recognition, CVPR 2010, 2010)
Lymph nodes have high clinical relevance but detection is challenging as they are hard to see due to low contrast and irregular shape. In this paper, a method for fully automatic mediastinal lymph node detection in 3-D computed tomography (CT) images of the chest area is proposed. Discriminative learning is used to detect lymph nodes based on their appearance. Because lymph nodes can easily be confused with other structures, it is vital to incorporate as much anatomical knowledge as possible to achieve good detection rates. Here, a learned prior of the spatial distribution is proposed to model this knowledge. As atlas matching is generally inaccurate in the chest area because of anatomical variations, this prior is not learned in the space of a single atlas, but in the space of multiple ones that are attached to anatomical structures. During test, the priors are weighted and merged according to spatial distances. Cross-validation on 54 CT datasets showed that the prior based detector yields a true positive rate of 52.3% for seven false positives per volume image, which is about two times better than without a spatial prior. ©2010 IEEE.

Lymphocytopenia Is an Independent Predictor of Unfavorable Functional Outcome in Spontaneous Intracerebral Hemorrhage - Giede-Jeppe, Antje; Bobinger, Tobias; Gerner, Stefan; Madzar, Dominik; Sembill, Jochen; Lücking, Hannes; Kloska, Stephan; Keil, Toni; Kuramatsu, Joji; Huttner, Hagen (Stroke, 2016)
Stroke-associated immunosuppression is an increasingly recognized factor triggering infections and thus potentially influencing outcome after stroke. Specifically, lymphocytopenia after intracerebral hemorrhage (ICH) has only been addressed in small-sized retrospective studies of mixed intracranial bleedings. This cohort study investigated the natural course of lymphocytopenia, parameters associated with lymphocytopenia on admission (LOA) and during stay, and evaluated the clinical impact of lymphocytopenia in solely ICH patients.This observational study included 855 consecutive patients with ICH. Patient demographics, clinical and neuroradiological data as well as laboratory and in-hospital measures were retrieved from institutional prospective databases. Functional 3-month outcome was assessed by mailed questionnaires. Lymphocytopenia was defined as <1.0 (10(9)/L) and was correlated with patient's characteristics and outcome.Prevalence of LOA was 27.3%. Patients with LOA showed significant associations with poorer neurological status (18 [10-32] versus 13 [5-24]; P<0.001), larger hematoma volume (18.5 [6.2-46.2] versus 12.8 [4.4-37.8]; P=0.006), and unfavorable outcome (74.7% versus 63.3%; P=0.0018). Natural course of lymphocyte count during hospital stay revealed a lymphocyte nadir of 1.1 (0.80-1.53 [10(9)/L]) at day 5. Focusing on patients with day-5-lymphocytopenia, compared with patients with LOA, revealed increased rates of infections (63 [71.6] versus 113 [48.5]; P<0.001) and poorer functional outcome at 3 months (76 [86.4] versus 175 [75.1); P=0.029). Adjusting for baseline confounders, multivariable logistic and receiver operating characteristics analyses documented independent associations of day-5-lymphocytopenia with unfavorable outcome (day-5-lymphocytopenia: odds ratio, 2.017 [95% confidence interval, 1.029-3.955], P=0.041; LOA: odds ratio, 1.391 [0.795-2.432], P=0.248; receiver operating characteristics: day-5-lymphocytopenia: area under the curve=0.673, P<0.0001, Youden's index=0.290; LOA: area under the curve=0.513, P=0.676, Youden's index=0.084), whereas receiver operating characteristics analyses revealed no association of age or hematoma volume with day-5-lymphocytopenia (age: area under the curve=0.540, P=0.198, Youden's index=0.106; volume: area under the curve=0.550, P=0.0898, Youden's index=0.1224).Lymphocytopenia is frequently present in patients with ICH and may represent an independent parameter associated with unfavorable functional outcome. Developing lymphocytopenia affected outcome even stronger than LOA, a finding that may open up new therapeutic avenues in specific subsets of patients with ICH.
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Machine Learning Algorithms for Early Detection of Bone Metastases in an Experimental Rat Model - Ellmann, Stephan; Seyler, Lisa; Gillmann, Clarissa; Popp, Vanessa; Treutlein, Christoph; Bozec, Aline; Uder, Michael; Bäuerle, Tobias (Journal of Visualized Experiments, 2020)
Machine learning (ML) algorithms permit the integration of different features into a model to perform classification or regression tasks with an accuracy exceeding its constituents. This protocol describes the development of an ML algorithm to predict the growth of breast cancer bone macrometastases in a rat model before any abnormalities are observable with standard imaging methods. Such an algorithm can facilitate the detection of early metastatic disease (i.e., micrometastasis) that is regularly missed during staging examinations. The applied metastasis model is site-specific, meaning that the rats develop metastases exclusively in their right hind leg. The model's tumor-take rate is 60%-80%, with macrometastases becoming visible in magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) in a subset of animals 30 days after induction, whereas a second subset of animals exhibit no tumor growth. Starting from image examinations acquired at an earlier time point, this protocol describes the extraction of features that indicate tissue vascularization detected by MRI, glucose metabolism by PET/CT, and the subsequent determination of the most relevant features for the prediction of macrometastatic disease. These features are then fed into a model-averaged neural network (avNNet) to classify the animals into one of two groups: one that will develop metastases and the other that will not develop any tumors. The protocol also describes the calculation of standard diagnostic parameters, such as overall accuracy, sensitivity, specificity, negative/positive predictive values, likelihood ratios, and the development of a receiver operating characteristic. An advantage of the proposed protocol is its flexibility, as it can be easily adapted to train a plethora of different ML algorithms with adjustable combinations of an unlimited number of features. Moreover, it can be used to analyze different problems in oncology, infection, and inflammation.
CRIS-Team Scopus Importer:2020-09-11

Machine Learning-Based Prediction of Glioma IDH Gene Mutation Status Using Physio-Metabolic MRI of Oxygen Metabolism and Neovascularization (A Bicenter Study) - Stadlbauer, Andreas; Nikolic, Katarina; Oberndorfer, Stefan; Marhold, Franz; Kinfe, Thomas Mehari; Meyer-Bäse, Anke; Bistrian, Diana Alina; Schnell, Oliver; Dörfler, Arnd (Cancers, 2024)
The mutational status of the isocitrate dehydrogenase (IDH) gene plays a key role in the treatment of glioma patients because it is known to affect energy metabolism pathways relevant to glioma. Physio-metabolic magnetic resonance imaging (MRI) enables the non-invasive analysis of oxygen metabolism and tissue hypoxia as well as associated neovascularization and microvascular architecture. However, evaluating such complex neuroimaging data requires computational support. Traditional machine learning algorithms and simple deep learning models were trained with radiomic features from clinical MRI (cMRI) or physio-metabolic MRI data. A total of 215 patients (first center: 166 participants + 16 participants for independent internal testing of the algorithms versus second site: 33 participants for independent external testing) were enrolled using two different physio-metabolic MRI protocols. The algorithms trained with physio-metabolic data demonstrated the best classification performance in independent internal testing: precision, 91.7%; accuracy, 87.5%; area under the receiver operating curve (AUROC), 0.979. In external testing, traditional machine learning models trained with cMRI data exhibited the best IDH classification results: precision, 84.9%; accuracy, 81.8%; and AUROC, 0.879. The poor performance for the physio-metabolic MRI approach appears to be explainable by site-dependent differences in data acquisition methodologies. The physio-metabolic MRI approach potentially supports reliable classification of IDH gene status in the presurgical stage of glioma patients. However, non-standardized protocols limit the level of evidence and underlie the need for a reproducible framework of data acquisition techniques.
CRIS-Team Scopus Importer:2024-04-05
Keywords: artificial intelligence; deep learning; glioma; IDH gene mutation; isocitrate dehydrogenase gene; machine learning; neurooncology; physio-metabolic MRI; preoperative classification

Machine Learning-Based Prediction of Knee Replacement in Persons with and Without Radiographic Osteoarthritis Using Clinical and Imaging Features of Osteoarthritis: The Multicenter Osteoarthritis Study - Jafarzadeh, S. Reza; Felson, David; Nevitt, Michael; Torner, James; Lewis, Cora; Roemer, Frank; Guermazi, Ali; Neogi, Tuhina (ARTHRITIS & RHEUMATOLOGY, 2020)
CRIS-Team WoS Importer:2021-01-15

Magnetic resonance cinematography of the fingers: a 3.0 Tesla feasibility study with comparison of incremental and continuous dynamic protocols - Bayer, Thomas; Adler, Werner; Janka, Rolf Matthias; Uder, Michael; Roemer, Frank (Skeletal Radiology, 2017)
To study the feasibility of magnetic resonance cinematography of the fingers (MRCF) with comparison of image quality of different protocols for depicting the finger anatomy during motion.MRCF was performed during a full flexion and extension movement in 14 healthy volunteers using a finger-gating device. Three real-time sequences (frame rates 17-59 images/min) and one proton density (PD) sequence (3 images/min) were acquired during incremental and continuous motion. Analyses were performed independently by three readers. Qualitative image analysis included Likert-scale grading from 0 (useless) to 5 (excellent) and specific visual analog scale (VAS) grading from 0 (insufficient) to 100 (excellent). Signal-to-noise calculation was performed. Overall percentage agreement and mean absolute disagreement were calculated.Within the real-time sequences a high frame-rate true fast imaging with steady-state free precession (TRUFI) yielded the best image quality with Likert and overall VAS scores of 3.0 ± 0.2 and 60.4 ± 25.3, respectively. The best sequence regarding image quality was an incremental PD with mean values of 4.8 ± 0.2 and 91.2 ± 9.4, respectively. Overall percentage agreement and mean absolute disagreement were 47.9 and 0.7, respectively. No statistically significant SNR differences were found between continuous and incremental motion for the real-time protocols.MRCF is feasible with appropriate image quality during continuous motion using a finger-gating device. Almost perfect image quality is achievable with incremental PD imaging, which represents a compromise for MRCF with the drawback of prolonged scanning time.
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Magnetic resonance-determined sodium removal from tissue stores in hemodialysis patients - Dahlmann, Anke; Dörfelt, Kathrin; Eicher, Florian; Linz, Peter; Kopp, Christoph; Mössinger, Irina; Horn, Stephan; Bueschges-Seraphin, Beatrix; Wabel, Peter; Hammon, Matthias; Eckardt, Kai-Uwe; Kotanko, Peter; et al. (Kidney International, 2015)
We have previously reported that sodium is stored in skin and muscle. The amounts stored in hemodialysis (HD) patients are unknown. We determined whether (23)Na magnetic resonance imaging (sodium-MRI) allows assessment of tissue sodium and its removal in 24 HD patients and 27 age-matched healthy controls. We also studied 20 HD patients before and shortly after HD with a batch dialysis system with direct measurement of sodium in dialysate and ultrafiltrate. Age was associated with higher tissue sodium content in controls. This increase was paralleled by an age-dependent decrease of circulating levels of vascular endothelial growth factor-C (VEGF-C). Older (>60 years) HD patients showed increased sodium and water in skin and muscle and lower VEGF-C levels compared with age-matched controls. After HD, patients with low VEGF-C levels had significantly higher skin sodium content compared with patients with high VEGF-C levels (low VEGF-C: 2.3 ng/ml and skin sodium: 24.3 mmol/l; high VEGF-C: 4.1 ng/ml and skin sodium: 18.2 mmol/l). Thus, sodium-MRI quantitatively detects sodium stored in skin and muscle in humans and allows studying sodium storage reduction in ESRD patients. Age and VEGF-C-related local tissue-specific clearance mechanisms may determine the efficacy of tissue sodium removal with HD. Prospective trials on the relationship between tissue sodium content and hard end points could provide new insights into sodium homeostasis, and clarify whether increased sodium storage is a cardiovascular risk factor.
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Magnetic Resonance Imaging and Bioelectrical Impedance Analysis to Assess Visceral and Abdominal Adipose Tissue - Chaudry, Oliver; Grimm, Alexandra; Friedberger, Andreas; Kemmler, Wolfgang; Uder, Michael; Jakob, Franz; Quick, Harald H.; von Stengel, Simon; Engelke, Klaus (Obesity, 2020)
Objective This study aimed to compare a state-of-the-art bioelectrical impedance analysis (BIA) device with two-point Dixon magnetic resonance imaging (MRI) for the quantification of visceral adipose tissue (VAT) as a health-related risk factor. Methods A total of 63 male participants were measured using a 3-T MRI scanner and a segmental, multifrequency BIA device. MRI generated fat fraction (FF) maps, in which VAT volume, total abdominal adipose tissue volume, and FF of visceral and total abdominal compartments were quantified. BIA estimated body fat mass and VAT area. Results Coefficients of determination between abdominal (r(2) = 0.75) and visceral compartments (r(2) = 0.78) were similar for both groups, but slopes differed by a factor of two. The ratio of visceral to total abdominal FF was increased in older men compared with younger men. This difference was not detected with BIA. MRI and BIA measurements of the total abdominal volume correlated moderately (r(2) = 0.31-0.56), and visceral measurements correlated poorly (r(2) = 0.13-0.44). Conclusions Visceral BIA measurements agreed better with MRI measurements of the total abdomen than of the visceral compartment, indicating that BIA visceral fat area assessment cannot differentiate adipose tissue between visceral and abdominal compartments in young and older participants.
CRIS-Team WoS Importer:2020-01-14

Magnetic resonance imaging assessment of knee osteoarthritis: current and developing new concepts and techniques - Hayashi, Daichi; Roemer, Frank; Guermazi, Ali (Clinical and Experimental Rheumatology, 2019)
Magnetic resonance imaging (MRI) is a well-established imaging technique for structural assessment of knee osteoarthritis (OA) particularly in a research context. Conventional MRI allows evaluation of morphological changes in osteoarthritis, and advanced compositional MRI techniques enable assessment of 'premorphologic' biochemical compositional changes of articular and periarticular tissues. Limitations of conventional radiography are well known, although radiography remains the primary imaging modality applied in osteoarthritis clinical trials to date. Hybrid techniques such as PET/MRI have been introduced, which may potentially supplement conventional imaging techniques. Artificial Intelligence (AI) such as deep learning with convolutional neural networks is becoming increasingly recognised as a supportive instrument to deepen our understanding of morphologic OA development and progression. In this narrative review article, we will first give summary of current concepts and widely used MRI assessment techniques of knee osteoarthritis. We will then describe more recent and novel MRI techniques focusing primarily on publications from the last 4 years (2016-2019).
CRIS-Team Scopus Importer:2019-10-25

Magnetic resonance imaging biomarkers for clinical routine assessment of microvascular architecture in glioma - Stadlbauer, Andreas; Zimmermann, Max; Heinz, Gertraud; Oberndorfer, Stefan; Dörfler, Arnd; Buchfelder, Michael; Roessler, Karl (Journal of Cerebral Blood Flow and Metabolism, 2017)
Knowledge about the topological and structural heterogeneity of the microvasculature is important for diagnosis and monitoring of glioma. A vessel caliber and type-dependent temporal shift in the magnetic resonance imaging signal forms the basis for vascular architecture mapping. This study introduced a clinically feasible approach for assessment of vascular pathologies in gliomas using vascular architecture mapping. Sixty consecutive patients with known or suspected gliomas were examined using vascular architecture mapping as part of the routine magnetic resonance imaging protocol. Maps of microvessel radius and density, which adapted to the vasculature-dependent temporal shift phenomenon, were calculated using a costume-made software tool. Microvessel radius and density were moderately to severely elevated in a heterogeneous, inversely correlated pattern within high-grade gliomas. Additionally, three new imaging biomarkers were introduced: Microvessel type indicator allowing differentiation between supplying arterial and draining venous microvasculature in high-grade gliomas. Vascular-induced bolus peak time shift may presumably be sensitive for early neovascularization in the infiltration zone. Surprisingly, curvature showed significant changes in peritumoral vasogenic edema which correlated with neovascularization in the tumor core of high-grade gliomas. These new magnetic resonance imaging biomarkers give insights into complexity and heterogeneity of vascular changes in glioma; however, histological validations in more well-defined patient populations are required.
EVALuna2:33149

Magnetic resonance imaging for brain stereotactic radiotherapy - A review of requirements and pitfalls - Putz, Florian; Mengling, Veit; Perrin, Rosalind; Masitho, Siti; Weissmann, Thomas; Roesch, Johannes; Bäuerle, Tobias; Janka, Rolf Matthias; Uder, Michael; Amarteifio, Patrick; Doussin, Sylvain; Schmidt, Manuel; et al. (Strahlentherapie und Onkologie, 2020)
Due to its superior soft tissue contrast, magnetic resonance imaging (MRI) is essential for many radiotherapy treatment indications. This is especially true for treatment planning in intracranial tumors, where MRI has a long-standing history for target delineation in clinical practice. Despite its routine use, care has to be taken when selecting and acquiring MRI studies for the purpose of radiotherapy treatment planning. Requirements on MRI are particularly demanding for intracranial stereotactic radiotherapy, where accurate imaging has a critical role in treatment success. However, MR images acquired for routine radiological assessment are frequently unsuitable for high-precision stereotactic radiotherapy as the requirements for imaging are significantly different for radiotherapy planning and diagnostic radiology. To assure that optimal imaging is used for treatment planning, the radiation oncologist needs proper knowledge of the most important requirements concerning the use of MRI in brain stereotactic radiotherapy. In the present review, we summarize and discuss the most relevant issues when using MR images for target volume delineation in intracranial stereotactic radiotherapy.
CRIS-Team WoS Importer:2020-04-10

Magnetic resonance imaging (MRI)-defined cartilage degeneration and joint pain are associated with poor physical function in knee osteoarthritis - the Oulu Knee Osteoarthritis study - Kaukinen, P.; Podlipska, J.; Guermazi, Ali; Niinimaki, Jaakko; Lehenkari, P.; Roemer, Frank; Nieminen, M. T.; Koski, J. M.; Saarakkala, S.; Arokoski, J. P. A. (Osteoarthritis and Cartilage, 2017)
The main aim was to investigate the associations between Magnetic Resonance Imaging (MRI)-defined structural pathologies of the knee and physical function.A cohort study with frequency matching on age and sex with eighty symptomatic subjects with knee pain and suspicion or diagnosis of knee osteoarthritis (OA) and 57 asymptomatic subjects was conducted. The subjects underwent knee MRI, and the severity of structural changes was graded by MRI Osteoarthritis Knee Score (MOAKS) in separate knee locations. WOMAC function subscores were recorded and physical function tests (20-m and 5-min walk, stair ascending and descending, timed up & go and repeated sit-to-stand tests) performed. The association between MRI-defined structural pathologies and physical function tests and WOMAC function subscores were evaluated by linear regression analysis with adjustment for demographic factors, other MRI-features and pain with using effect size (ES) as a measure of the magnitude of an association.Cartilage degeneration showed significant association with poor physical performance in TUG-, stair ascending and descending-, 20-m- and 5-min walk-tests (ESs in the subjects with cartilage degeneration anywhere between 0.134 [95%CI 0.037-0.238] and 0.224 [0.013-0.335]) and with increased WOMAC function subscore (ES in the subjects with cartilage degeneration anywhere 0.088 [0.012-0.103]). Also, lateral meniscus maceration and extrusion were associated with poor performance in stair ascending test (ESs 0.067 [0.008-0.163] and 0.077 [0.012-0.177]).After adjustments cartilage degeneration was associated with both decreased self-reported physical function and poor performance in the physical function tests. Furthermore, subjects with lateral meniscus maceration and extrusions showed significantly worse performance in stair ascending tests.
EVALuna2:14706

Magnetic resonance imaging of Hoffa's fat pad and relevance for osteoarthritis research: a narrative review - Roemer, Frank; Jarraya, M.; Felson, D. T.; Hayashi, D.; Crema, M. D.; Loeuille, D.; Guermazi, Ali (Osteoarthritis and Cartilage, 2016)
To give an illustrative overview of Hoffa's fat pad pathology with a radiologic emphasis on the anatomy, on technical considerations, and on imaging differential diagnoses in the context of osteoarthritis (OA) imaging research.A PubMed database search including only English literature and covering a 20 year period was performed. The search was based on but no limited to the query terms "Hoffa", "Hoffa's fat pad" or "infrapatellar fat pad (IPFP)" in combination with "synovitis", "OA", and "magnetic resonance imaging (MRI)". The literature search yielded 289 publications that were screened for relevance; additional references were included when these were considered of importance.Several anatomic variants and pathologic conditions may be encountered when assessing Hoffa's fat pad including tumors and tumor-like lesions such as osteochondroma, tenosynovial giant cell tumor (TGCT) (and pigmented nodular synovitis) and arthrofibrosis, traumatic changes including contusions and anatomic variants such as recesses. The latter may be accountable for differences in cross-sectional area or volume changes over time. Signal changes are commonly used in OA research as surrogate markers for synovitis but are non-specific findings.Quantitative approaches to evaluate 3D parameters of Hoffa's fat pad are increasingly applied and their role in regard to structural progression and clinical manifestations of disease needs to be further elucidated. In applying such approaches, knowledge of the detailed anatomy and potential pitfalls that may be a result of anatomical variants, inflammatory disease manifestations and additional diverse pathologies encountered seems to be paramount.
EVALuna2:14689

Magnetic resonance imaging of intraductal papillomas: typical findings and differential diagnosis - Dietzel, Matthias; Kaiser, Clemens; Baltzer, Pascal A. T. (Journal of Computer Assisted Tomography, 2015)
Even upon core biopsy, accurate classification of benign intraductal papillomas (IPs) can be difficult. Accordingly, IPs are still frequently surgically resected. Therefore, accurate classification of IP by magnetic resonance mammography (MRM) would potentially optimize patient management. However, the few investigations assessing MRM of IP included small patient collectives, and overall accuracy is still unknown. We performed this investigation to analyze the morphologic and dynamic MRM profiles of IP in more detail and to identify the overall accuracy of MRM for differential diagnosis of IP versus malignant breast lesions.Consecutive patients scheduled for MRM (standardized scanning protocols: dynamic T1-weighted gradient echo before/after Gd-DTPA [gadolinium diethylenetriamine pentaacetate; 0.1 mmol/kg body weight]; T2-weighted turbo spin echo) with subsequent surgicopathologic verification were enrolled. For the detailed assessment of morphologic and dynamic profiles, 2 experienced radiologists (>500 MRM examinations; blinded to surgicopathologic verification) performed prospective evaluation of MRM, in consensus, applying 17 predefined MRM descriptors. From this database, all patients showing IP (n = 83) or malignant breast lesions (n = 648) were further evaluated statistically: univariate analyses (association of single descriptors with IP/breast cancer: contingency table statistics) and multivariate analyses were performed to identify accurate descriptor combinations (CHAID [CHi-squared Automatic Interaction Detection]) and overall accuracy of MRM for differential diagnosis of IP versus malignant breast lesions (logistic regression; receiver operating characteristics [ROC], area under the ROC curve).There were 82.4% of MRM descriptors significantly associated with IP (n = 14; P < 0.05). The accuracy of single descriptors (odds ratio [OR], <=10.6) could be further increased by descriptor combinations (double combination: OR <=12.7; triple combination: OR <=15.0). With area under the ROC curve = 0.90, there was a high overall accuracy of MRM for the differential diagnosis of IP versus malignant breast lesions.A detailed assessment of MRM allows precise characterization of benign IPs and accurate differentiation from malignant breast lesions.
EVALuna2:23003

Magnetic resonance imaging techniques for the quantitative analysis of skeletal muscle: State of the art. - Engelke, Klaus; Chaudry, Oliver; Gast, Lena; Eldib, Mootaz AB; Wang, Ling; Laredo, Jean Denis; Schett, Georg; Nagel, Armin Michael (Journal of Orthopaedic Translation, 2023)
BACKGROUND: Magnetic resonance imaging (MRI) is the dominant 3D imaging modality to quantify muscle properties in skeletal muscle disorders, in inherited and acquired muscle diseases, and in sarcopenia, in cachexia and frailty. METHODS: This review covers T1 weighted and Dixon sequences, introduces T2 mapping, diffusion tensor imaging (DTI) and non-proton MRI. Technical concepts, strengths, limitations and translational aspects of these techniques are discussed in detail. Examples of clinical applications are outlined. For comparison 31P-and 13C-MR Spectroscopy are also addressed. RESULTS: MRI technology provides a rich toolset to assess muscle deterioration. In addition to classical measures such as muscle atrophy using T1 weighted imaging and fat infiltration using Dixon sequences, parameters characterizing inflammation from T2 maps, tissue sodium using non-proton MRI techniques or concentration or fiber architecture using diffusion tensor imaging may be useful for an even earlier diagnosis of the impairment of muscle quality. CONCLUSION: Quantitative MRI provides new options for muscle research and clinical applications. Current limitations that also impair its more widespread use in clinical trials are lack of standardization, ambiguity of image segmentation and analysis approaches, a multitude of outcome parameters without a clear strategy which ones to use and the lack of normal data.
EVALuna2:540329

Magnetoencephalography for epileptic focus localization in a series of 1000 cases. - Rampp, Stefan; Stefan, Hermann; Wu, Xintong; Kaltenhäuser, Martin; Maess, Burkhard; Schmitt, Friedhelm C.; Wolters, Carsten H.; Hamer, Hajo; Kasper, Burkhard S.; Schwab, Stefan; Blümcke, Ingmar; Rössler, Karl; et al. (Brain, 2019)
The aim of epilepsy surgery in patients with focal, pharmacoresistant epilepsies is to remove the complete epileptogenic zone to achieve long-term seizure freedom. In addition to a spectrum of diagnostic methods, magnetoencephalography focus localization is used for planning of epilepsy surgery. We present results from a retrospective observational cohort study of 1000 patients, evaluated using magnetoencephalography at the University Hospital Erlangen over the time span of 28 years. One thousand consecutive cases were included in the study, evaluated at the University Hospital Erlangen between 1990 and 2018. All patients underwent magnetoencephalography as part of clinical workup for epilepsy surgery. Of these, 405 underwent epilepsy surgery after magnetoencephalography, with postsurgical follow-ups of up to 20 years. Sensitivity for interictal epileptic activity was evaluated, in addition to concordance of localization with the consensus of presurgical workup on a lobar level. We evaluate magnetoencephalography characteristics of patients who underwent epilepsy surgery versus patients who did not proceed to surgery. In operated patients, resection of magnetoencephalography localizations were related to postsurgical seizure outcomes, including long-term results after several years. In comparison, association of lesionectomy with seizure outcomes was analysed. Measures of diagnostic accuracy were calculated for magnetoencephalography resection and lesionectomy. Sensitivity for interictal epileptic activity was 72% with significant differences between temporal and extra-temporal lobe epilepsy. Magnetoencephalography was concordant with the presurgical consensus in 51% and showed additional or more focal involvement in an additional 32%. Patients who proceeded to surgery showed a significantly higher percentage of monofocal magnetoencephalography results. Complete magnetoencephalography resection was associated with significantly higher chances to achieve seizure freedom in the short and long-term. Diagnostic accuracy was significant in temporal and extra-temporal lobe cases, but was significantly higher in extra-temporal lobe epilepsy (diagnostic odds ratios of 4.4 and 41.6). Odds ratios were also higher in non-lesional versus lesional cases (42.0 versus 6.2). The results show that magnetoencephalography provides non-redundant information, which significantly contributes to patient selection, focus localization and ultimately long-term seizure freedom after epilepsy surgery. Specifically in extra-temporal lobe epilepsy and non-lesional cases, magnetoencephalography provides excellent accuracy.
EVALuna2:204465

Magnetoencephalography for epileptic focus localization in a series of 1000 cases - Rampp, Stefan; Stefan, Hermann; Wu, Xueqing; Kaltenhäuser, Martin; Maess, Burkhard; Schmitt, Friedhelm C.; Wolters, Carsten H.; Hamer, Hajo; Kasper, Burkhard; Schwab, Stefan; Dörfler, Arnd; Blümcke, Ingmar; et al. (Brain, 2019)
The aim of epilepsy surgery in patients with focal, pharmacoresistant epilepsies is to remove the complete epileptogenic zone to achieve long-term seizure freedom. In addition to a spectrum of diagnostic methods, magnetoencephalography focus localization is used for planning of epilepsy surgery. We present results from a retrospective observational cohort study of 1000 patients, evaluated using magnetoencephalography at the University Hospital Erlangen over the time span of 28 years. One thousand consecutive cases were included in the study, evaluated at the University Hospital Erlangen between 1990 and 2018. All patients underwent magnetoencephalography as part of clinical workup for epilepsy surgery. Of these, 405 underwent epilepsy surgery after magnetoencephalography, with postsurgical follow-ups of up to 20 years. Sensitivity for interictal epileptic activity was evaluated, in addition to concordance of localization with the consensus of presurgical workup on a lobar level. We evaluate magnetoencephalography characteristics of patients who underwent epilepsy surgery versus patients who did not proceed to surgery. In operated patients, resection of magnetoencephalography localizations were related to postsurgical seizure outcomes, including long-term results after several years. In comparison, association of lesionectomy with seizure outcomes was analysed. Measures of diagnostic accuracy were calculated for magnetoencephalography resection and lesionectomy. Sensitivity for interictal epileptic activity was 72% with significant differences between temporal and extra-temporal lobe epilepsy. Magnetoencephalography was concordant with the presurgical consensus in 51% and showed additional or more focal involvement in an additional 32%. Patients who proceeded to surgery showed a significantly higher percentage of monofocal magnetoencephalography results. Complete magnetoencephalography resection was associated with significantly higher chances to achieve seizure freedom in the short and long-term. Diagnostic accuracy was significant in temporal and extra-temporal lobe cases, but was significantly higher in extra-temporal lobe epilepsy (diagnostic odds ratios of 4.4 and 41.6). Odds ratios were also higher in non-lesional versus lesional cases (42.0 versus 6.2). The results show that magnetoencephalography provides non-redundant information, which significantly contributes to patient selection, focus localization and ultimately long-term seizure freedom after epilepsy surgery. Specifically in extra-temporal lobe epilepsy and non-lesional cases, magnetoencephalography provides excellent accuracy.
CRIS-Team Scopus Importer:2019-10-08
Keywords: epilepsy; epilepsy surgery; long-term outcome; magnetic source imaging; magnetoencephalography

Malignant epithelioid peripheral nerve sheath tumor with prominent reticular/microcystic pattern in a child: a low-grade neoplasm with 18-years follow-up - Agaimy, Abbas; Stachel, Daniel; Jüngert, Jörg; Radkow, Tanja; Carbon, Roman; Metzler, Markus; Holter, Wolfgang (Applied Immunohistochemistry & Molecular Morphology, 2014)
Malignant peripheral nerve sheath tumors (MPNSTs) constitute <2% of soft tissue neoplasms in children and display a wide histologic spectrum including low-grade and epithelioid variants, although most are high-grade spindle cell sarcomas. Here, we describe an unusual case of a large retroperitoneal epithelioid MPNST diagnosed in a 7-year-old girl without family history or clinical features of neurofibromatosis type 1. The patient was treated by repeated surgical interventions, polychemotherapy, autologous stem cell transplantation, and irradiation therapy. Over the years, she developed multiple disseminated abdominal recurrences but is currently alive with very slowly progressing disseminated intra-abdominal disease 18 years from initial diagnosis. Histologically, the tumor was composed of medium-sized polygonal and ovoid-to-spindled cells set within a copious myxoid matrix with a prominent reticular and microcystic pattern reminiscent of the recently described reticular/microcystic schwannoma. Immunohistochemistry revealed strong and diffuse expression of S100, CD56, CD57, collagen IV, and neuron-specific enolase, with negativity for perineurial cell markers (claudin-1, epithelial membrane antigen, and glucose transporter-1) and other lineage-specific mesenchymal and epithelial antigens. This unusual variant of low-grade MPNST must be differentiated from a variety of other entities, in particular benign perineurioma, myxoid neurofibroma, and benign reticular/microcystic schwannoma. Confinement of the recurrent disease to the abdominal cavity emphasizes the necessity of primary curative wide excision of this highly recurring but nonmetastasizing low-grade neoplasm.
EVALuna2:6527

Mammakarzinom: Texturanalyse zur Prädiktion des Therapieansprechens - Dietzel, Matthias (Röfo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2020)
CRIS-Team Scopus Importer:2021-04-19

Mammakarzinom: Texturanalyse zur Prädiktion des Therapieansprechens - Dietzel, Matthias (TumorDiagnostik & Therapie, 2021)
CRIS-Team Scopus Importer:2021-04-16